2022 Associate
Benefits Book
Summary Plan Descriptions
What’s inside
Medical plan
Life insurance and disability plans
Pharmacy benefit
Associate Stock Purchase Plan
Dental plan
Vision plan
Walmart 401(k) Plan
…and much more
Effective January 1, 2022
Walmart 401(k) Plan effective February 1, 2022
Version 1.4
| Aug. 2022
Welcome to your
2022 Associate
Benefits Book
This is where you’ll find the Summary Plan Descriptions (SPDs)
for the Associates’ Health and Welfare Plan (the Plan) and the
Walmart 401(k) Plan.
The prospectus for the Associate Stock Purchase Plan is here, too.
Check out the table of contents for a complete list of what
you’ll find in this book. It’s a great resource to help you
understand your benefits.
Lots of information.
So easy to find.
When you download the 2022 Associate Benefits Book from One.Walmart.com,
you’ll have answers to your benefit questions at your fingertips.
Just launch the PDF with Adobe Reader and click “Edit” on the toolbar. Then
click “Find,” and enter a word or phrase that describes what you’re looking for,
like “preventive” or “copay.” Easy!
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Table of contents
The Associates’ Health and Welfare Plan
Eligibility and enrollment
Eligibility and benefits for associates in Hawaii
The medical plan
The pharmacy benefit
Health savings account (HSA)
The dental plan
The vision plan
COBRA
Resources for Living®
Critical illness insurance
Accident insurance
Company‑paid life insurance
The Associate Stock Purchase Plan (ASPP)
The Walmart 401(k) Plan
For more information
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56
100
106
114
124
130
138
142
148
156
Optional associate life insurance
Optional dependent life insurance
Accidental death and dismemberment
(AD&D) insurance
Business travel accident insurance
Full‑time hourly short‑term disability
Salaried short‑term disability plan
Truck driver short‑term disability plan
Full‑time hourly and salaried
long‑term disability
Truck driver long‑term disability
Claims and appeals
Legal information
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168
174
182
188
198
208
218
226
234
254
268
280
308
Information obtained during communications with Walmart Inc. or any
Plan service provider does not waive any provision or limitation of
the Plan. Information given or statements made through any form of
communication do not guarantee payment of benefits. In addition,
benefits quotes that are given by phone are based wholly on the
information supplied at the time. If additional relevant information is
discovered, it may affect payment of your claim. All benefits are subject
to eligibility, payment of premiums, limitations, and all exclusions outlined
in the applicable Plan documents, including any insurance policies. You
can request a copy of the documents governing these plans by writing to:
Custodian of Records, People Services, 508 SW 8th Street, Bentonville,
Arkansas 72716‑3500.
Atención Asociados Hispanos: Este folleto contiene un resumen
en inglés de los derechos y beneficios para todos losasociados bajo el
plan de beneficios de Walmart. Si Ud tienedificultades para entender
cualquier parte de este folletopuede dirigirse a la siguiente dirección:
People Services, 508 SW 8th Street, Bentonville, Arkansas 72716‑3500.
O puede llamar para cualquier pregunta al 800‑421‑1362. Tenemos
asociados quienes hablan Español y pueden ayudarles a Ud comprender
sus beneficios de Walmart. El Libro de beneficios para asociados esta
disponible en Español. Si usted desea una copia en Español, favor de
ver su Representante de Personal.
Eligibility and
enrollment
The Associates’ Health and Welfare Plan
Associate eligibility
Part‑time hourly and temporary associates: eligibility checks for medical benefits
Dependent eligibility
Legal documentation for dependent coverage
Dependents who are not eligible
When your dependent becomes ineligible
When you enroll for benefits
When coverage is effective
If you leave the company and are rehired
Effective dates for benefits under the Plan
Enrollment and effective dates by job classification
Paying for your benefits
Tobacco rates
Continuing benefit coverage if you go on a leave of absence
Continuing benefit coverage while disabled
Status change events
If your job classification changes
Transferring from one job classification to another
Qualified Medical Child Support Orders (QMCSO)
When your Plan coverage ends
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30
30
48
49
If you have Medicare or will become eligible for Medicare in the next 12 months,
you have more choices for your prescription drug coverage. See page 261 in the
Legal information chapter for more details.
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Eligibility and enrollment
RESOURCES
Find What You Need
Online
Other Resources
• Enroll in Walmart benefits
• Notify People Services within 60
days of a status change event
Notify People Services if you have
questions about the payroll deductions
for your benefits
Pay premiums for benefits while on
a leave of absence
Go to
One.Walmart.com/Enroll
Call People Services at 800-421-1362
Call People Services at 800-421-1362
See Continuing benefit coverage if you go on a leave
of absence in this chapter for detailed information.
If you are required to pay your premiums to keep
coverage current, failure to do so will result in a
cancellation of coverage. You may pay by credit or
debit card with a Visa, MasterCard, American Express,
or Discover card by going to One.Walmart.com/Enroll
and choosing “make a payment” or by calling
800-421-1362 and saying “make a payment.”
You may also send a check or money order payable to
the Associates’ Health and Welfare Trust to:
Walmart People Services
P.O. Box 1039
Department 3001
Lowell, Arkansas 72745
To ensure timely posting of your payment, be sure
to include your WIN (Walmart ID) number and work
location on the check.
What you need to know about eligibility and enrollment
• You can enroll for benefits during your initial enrollment period as a newly eligible associate, during Annual Enrollment,
or when you have a status change event.
• Your job classification (or changes to your job classification) determines when your initial enrollment period begins.
If you are a Hawaii associate, see the Eligibility and benefits for associates in Hawaii chapter.
• Medical, dental, vision, critical illness, accident, accidental death and dismemberment (AD&D), short‑term disability
enhanced, long‑term disability, and truck driver long‑term disability benefits cannot be changed, added, or dropped
outside an initial enrollment period except during Annual Enrollment or after you have a status change event.
• You may enroll in, drop, or change optional life insurance benefits at any time but if you enroll or increase your
coverage after your initial enrollment period, you will have to provide Proof of Good Health.
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The Associates’ Health and
Welfare Plan
The Associates’ Health and Welfare Plan (the Plan) is a
comprehensive employee benefit plan that offers medical,
dental, vision, critical illness insurance, accident insurance,
AD&D, business travel accident insurance, life insurance,
disability, and Resources for Living (employee assistance
and wellness) benefits to eligible associates and their
eligible family members. Eligibility for these benefits is
described in this chapter, and the terms and conditions for
these benefits are described in the applicable chapters of
this 2022 Associate Benefits Book. The Plan is sponsored by
Walmart Inc. (the company).
You are enrolled automatically for certain benefits under
the Plan on your date of hire or a later date. For other
benefits, however, you must enroll to have coverage. Refer
to the Enrollment and effective dates by job classification
section in this chapter for details about initial enrollment
periods and when coverage is effective, for all benefits
available under the Plan.
Associate eligibility
The benefits you are eligible for may depend on a number of
factors, which may include your date of hire, average weekly
hours, and your job classification in the Walmart Inc. payroll
system. In addition, for most benefits, you may be required
to meet an eligibility waiting period. See the Enrollment and
effective dates by job classification section in this chapter
for a list of the benefits you are eligible for and for your
eligibility waiting period based on your job classification.
Our expectation is that you will use correct and accurate
information when applying for or enrolling in benefits.
If you do not, you may be subject to the loss of benefits
and/or termination of employment. To review Walmart’s
policy about intentional dishonesty, refer to the Statement
of Ethics, which can be found on One.Walmart.com. See
Legal documentation for dependent coverage later in this
chapter for information about documents that may be
requested of you to verify dependent eligibility.
NOTE: Your eligibility for benefits is determined by the
eligibility rules detailed in this Associate Benefits Book. To
the extent that any information provided to you through
other sources conflicts with the Associate Benefits Book, the
eligibility rules in the Associate Benefits Book will control.
MANAGEMENT ASSOCIATE ELIGIBILITY
To be eligible for benefits as a management associate, you
must be classified in the company’s payroll system as a
management associate, management trainee, California
pharmacist, or full‑time truck driver.
FULL-TIME HOURLY ASSOCIATE ELIGIBILITY
To be eligible for benefits as a full‑time hourly associate,
you must be classified in the company’s payroll system as
a full‑time hourly associate.
If you are a full‑time hourly associate in Hawaii, refer to
the chapter titled Eligibility and benefits for associates
in Hawaii.
PART-TIME HOURLY ASSOCIATE ELIGIBILITY
To be eligible for benefits as a part‑time hourly associate,
you must be classified in the company’s payroll system as a
part‑time hourly associate.
To be eligible to enroll in medical benefits, you must
work an average of at least 30 hours per week, with the
following exceptions:
• Part‑time hourly pharmacists hired prior to February 1, 2012,
do not need to work a minimum number of hours per week.
• Part‑time hourly pharmacists hired on or after
February 1, 2012, must work an average of at least 24
hours per week.
• Part‑time hourly associates in the field supply chain must
work an average of at least 24 hours per week.
• Part‑time hourly nurse practitioners must work an average
of at least 24 hours per week.
• Part‑time hourly associates in Hawaii are subject to
different rules. Refer to the chapter titled Eligibility and
benefits for associates in Hawaii for details.
If you are a part‑time hourly associate, your hours worked
will be reviewed to determine your eligibility for medical
benefits. For more information, see the section titled
Part-time hourly and temporary associates: eligibility
checks for medical benefits.
PART-TIME TRUCK DRIVER ELIGIBILITY
To be eligible for benefits as a part‑time truck driver, you
must be classified in the company’s payroll system as a
part‑time truck driver. You do not need to work a minimum
numbers of hours per week to be eligible to enroll in
medical benefits as a part‑time truck driver.
TEMPORARY ASSOCIATE ELIGIBILITY
To be eligible for benefits as a temporary associate, you
must be classified in the company’s payroll system as a
temporary associate.
To be eligible to enroll in medical benefits, you must
work an average of at least 30 hours per week, with the
following exceptions:
• Temporary hourly associates in the field supply chain must
work an average of at least 24 hours per week.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
• Temporary associates in Hawaii are subject to different
rules. Refer to the chapter titled Eligibility and benefits
for associates in Hawaii for details.
If you are a temporary associate, your hours worked will be
reviewed to determine your eligibility for medical benefits.
For more information, see the section titled Part-time
hourly and temporary associates: eligibility checks for
medical benefits.
ASSOCIATES WHO ARE NOT ELIGIBLE
You are not eligible for the Plan if you fall in any of the
following categories, even if you are reclassified by a court,
the IRS, or the Department of Labor as a common‑law
employee of the company or any participating affiliate:
• A leased employee
• A nonresident alien (except for optional associate life
insurance, optional dependent life insurance, accidental
death and disability insurance, and business travel accident
insurance, and unless covered under a specific insurance
policy for expatriates or third‑country nationals who are
employed by the company)
• An independent contractor
• A consultant
• An associate residing outside the United States
• An individual who is not classified as an associate of the
company or its participating affiliates
• An associate who is enrolled in Medicare Part D (applicable
only to eligibility for medical plan options, including HMO
and the PPO Plan options), or
• An associate covered by a collective bargaining agreement,
to the extent that the agreement does not provide for
participation in the Plan.
ELIGIBILITY INFORMATION FOR ADDITIONAL
ASSOCIATE CATEGORIES
Associates in HMO and PPO Plan options: HMO and PPO
Plan options are available for some work locations. The
policies and enrollment materials for HMO and PPO Plan
options may describe different eligibility requirements and
waiting periods than those described in this chapter. If there
is any difference between an HMO or the PPO Plan option’s
eligibility terms and the eligibility terms of the Associates’
Medical Plan (AMP) as described in this chapter, eligibility
terms in this chapter will control.
In addition, some HMOs require participants to accept an
arbitration agreement, where permitted by law, before
coverage under the HMO will become effective. If an HMO is
available in your area and you enroll, your agreement must be
received by the HMO within 60 days of your initial enrollment
or your HMO coverage will not take effect. If the HMO
does not receive your agreement, you will not have medical
coverage under the AMP and will not be able to enroll again
until the next Annual Enrollment or until you have a valid
status change event, as described later in this chapter.
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Hawaii associates: Special rules govern benefits eligibility
and enrollment in the state of Hawaii. If you are a full‑time
hourly, part‑time hourly, or temporary associate in Hawaii,
please refer to the chapter titled Eligibility and benefits
for associates in Hawaii. For management associates in
Hawaii, the eligibility and enrollment terms described in this
Eligibility and enrollment chapter apply.
Localized associates: If you have been approved by
the company as having localized status, you and your
dependents residing in the United States are eligible for
the same benefits under the Plan as associates who are
United States citizens residing and working in the United
States. Any applicable waiting period is waived. You are
not eligible for expatriate coverage under the Plan. If you
are a localized associate and an eligible dependent resides
outside the United States, medical claims will be processed
as network benefits regardless of the provider’s network
status and paid at the applicable copay or coinsurance rate
for network charges, subject to applicable limitations and
exclusions under the Plan. You or your enrolled dependents
must file a claim for reimbursement under the Plan’s claims
procedures.
Part-time hourly and temporary
associates: eligibility checks for
medical benefits
In this section you’ll find descriptions of three
eligibility checks conducted to determine
initial and ongoing medical (and other
benefits) eligibility for part‑time hourly and
temporary associates, as follows:
• Measurement of hours at 60‑day intervals
during the first 52 weeks of employment to
determine initial eligibility
• Initial check when you have been employed
for 52 weeks to determine initial eligibility
• Annual check to determine eligibility for
medical benefits in the next calendar year
Note that the eligibility checks described in
this section do not apply to part‑time hourly
and temporary associates in Hawaii.
60-DAY MEASUREMENTS OF HOURS
CONDUCTED DURING THE FIRST 52 WEEKS
OF EMPLOYMENT
If you are a part‑time hourly or temporary associate
(other than a part‑time or temporary associate in Hawaii,
a part‑time truck driver or a part‑time hourly pharmacist
hired before February 1, 2012), your hours worked will be
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measured to determine whether you are eligible for benefits
described in the Part-time hourly and temporary associates
chart later in this chapter, before the end of your first 52
weeks of employment.
Except as described below, your average hours worked per
week will be measured every 60 days following your date
of hire. The one exception is the very first measurement
cycle; your hours will be measured over the first 59 days
of employment, beginning with your date of hire, and that
measurement will take place on your 60th day of employment.
Subsequent measurement cycles will occur every 60 days
thereafter and will include hours worked on each of those
60 days. The measurement cycles will continue until you either
are determined to have worked an average of 30 hours per
week during any measurement cycle (24 hours for part‑time
nurse practitioners, part‑time hourly pharmacists hired on or
after February 1, 2012, and part‑time hourly and temporary
associates in the field supply chain) or you have been
employed for 52 weeks, whichever is earlier. There will be six
total measurements during your first year of employment.
No 60‑day check will be performed after the earlier of 1) the
date on which you are determined to have worked an average
of 30 hours per week during any 60‑day measurement cycle,
or 2) the date on which you reach the end of your initial
measurement period, as described later in this chapter.
First measurement cycle: For the first measurement
cycle, your hours will be measured over the first 59 days of
employment, beginning with your date of hire, as explained
above. If you work an average of at least 30 hours a week
during your first measurement cycle (24 hours for part‑time
nurse practitioners, part‑time hourly pharmacists hired on or
after February 1, 2012, and part‑time hourly and temporary
associates in the field supply chain), without a break in
employment of greater than 30 days, you will become
eligible for benefits at the close of that measurement cycle.
Specifically, you would be eligible for benefits described in
the Part-time hourly and temporary associates chart later in
this chapter, which would generally be effective on the first
day of the month in which your 89th day of employment
occurs, subject to any applicable requirements.
For example, if your date of hire is April 16, 2022, your
average hours worked from that day through June 13, 2022
will be measured on your 60th day of employment, June 14.
If you work an average of at least 30 hours per week during
this first measurement cycle (24 hours for part‑time nurse
practitioners, part‑time hourly pharmacists hired on or
after February 1, 2012, and part‑time hourly and temporary
associates in the field supply chain), as stated above, you will
be eligible for benefits, which would generally be effective
on July 1, subject to any applicable requirements and
assuming you enroll in a timely manner.
Subsequent 60-day measurement cycles: If you do
not work an average of at least 30 hours a week during
your first measurement cycle (24 hours for part‑time
nurse practitioners, part‑time hourly pharmacists hired
on or after February 1, 2012, and part‑time hourly and
temporary associates in the field supply chain), but you
do work the required average number of hours per week
during any subsequent 60‑day measurement cycle,
without a break in employment of greater than 30 days,
you will become eligible for benefits described in the
Part-time hourly and temporary associates chart later in this
chapter, which would generally be effective on the first day
of the month in which your 89th day of employment occurs,
after the successful 60‑day measurement cycle began,
subject to any applicable requirements and assuming you
enroll in a timely manner.
For example, if your date of hire is April 16, 2022, your
average hours worked from that day through June 13, 2022
will be measured on your 60th day of employment, June 14.
If you did not work an average of at least 30 hours per week
over this first measurement cycle (24 hours for part‑time
nurse practitioners, part‑time hourly pharmacists hired
on or after February 1, 2012, and part‑time hourly and
temporary associates in the field supply chain), your next
60‑day measurement cycle will run from June 14 through
August 12 and your hours worked over this 60‑day period
will be measured on August 13. If you work an average of
at least 30 hours per week over this second measurement
cycle (24 hours for part‑time nurse practitioners, part‑time
hourly pharmacists hired on or after February 1, 2012, and
part‑time hourly and temporary associates in the field
supply chain), your coverage would generally be effective
September 1, 2022. This is the first day of the month in
which your 89th day of employment occurs, as measured
from the first day of the second measurement cycle. Your
coverage would be subject to any applicable requirements
and assuming you enroll in a timely manner.
If you meet the average‑hours‑worked requirement as
described above, you will be eligible for the benefits
described in the Part-time hourly and temporary associates
chart later in this chapter. If you do not enroll when you
are initially eligible, your eligibility for medical coverage
continues through the end of the calendar year immediately
following the calendar year in which coverage is first offered
to you. During that period of eligibility, you will only be
permitted to enroll during Annual Enrollment or if you have
a status change event, as described in the Status change
events section later in this chapter. Your eligibility for
medical benefits will not be checked again until the annual
eligibility check, as described later in this chapter, which
occurs during the fall of the calendar year immediately
following the calendar year in which medical coverage is
first offered to you. Your eligibility for the other benefits
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described in the Part-time hourly and temporary associates
chart will continue as long as you remain a part‑time hourly or
temporary associate, subject to any applicable requirements.
In the example above, if you elect medical coverage, your
medical coverage (if you enroll in a timely manner) would
continue through the end of 2023. If you do not elect
medical coverage when initially eligible, your eligibility
will continue through 2023 but you will only be permitted
to enroll during Annual Enrollment in the fall of 2022 for
2023 benefit coverage or if you have a status change event.
To determine eligibility for medical benefits for years after
2023, you would be subject to annual eligibility checks, as
described later in this chapter.
If you take time off during any 60-day
measurement cycle
If you take any type of unpaid time off that is not an
approved leave of absence, as described later in this chapter,
your number of actual hours worked will still be used to
calculate your average hours for the 60‑day measurement
cycle (even if it is zero) in which the absence occurs.
If your absence is an approved leave (including for jury duty,
Family and Medical Leave Act of 1993 [“FMLA”] leave, or
military leave), the calculation of your average hours worked
will be based on the number of days during the 60‑day
measurement cycle that you were not on the approved
leave. For example, if you take an approved leave during five
days of the 60‑day measurement cycle, your average hours
worked will be calculated over 55 days rather than 60.
If you leave the company and are rehired
For purposes of the 60‑day measurement cycles, if you
return to employment as a part‑time hourly or temporary
associate within 30 days after leaving during the first
52 weeks of employment, you will be treated as if you had
not left. If you were enrolled in medical coverage before
you left, you will be enrolled automatically in medical
coverage when you return (or the most similar coverage
offered under the AMP), with a break in coverage during
the period of your absence for which premiums were not
paid. The medical coverage will continue through the end of
the calendar year immediately following the calendar year
in which coverage is first offered to you.
• If you are rehired in the same calendar year that includes
your termination date, your annual deductible and out‑of‑
pocket maximum under the AMP for the calendar year in
which you terminated will not be reset.
• If you are rehired in a different calendar year than the
calendar year that includes your termination date, you
will be responsible for meeting the new deductible and
out‑of‑pocket maximum for that year in their entirety.
You will have 60 days after resuming employment to drop
or otherwise change the coverage in which you were
enrolled automatically.
If you were eligible for medical coverage (but not enrolled)
when you left, you will be eligible to enroll in medical
coverage upon your rehire (if you do so in a timely manner),
provided you return prior to the end of the calendar year
following the calendar year in which you were first offered
coverage. For purposes of this paragraph, this is the “initial
eligibility period.” If you do not enroll in coverage when you
return, your eligibility will continue through the end of the
initial eligibility period. You will be eligible to elect coverage
through the remainder of the initial eligibility period if you
have a status change event or during the Annual Enrollment
period that occurs in the fall of the calendar year in which
you were first offered coverage. You will not be able to
enroll in coverage during the Annual Enrollment period that
falls within the initial eligibility period if you return in the
year in which the initial eligibility period ends unless you are
eligible for coverage for the next calendar year, based on
the annual eligibility check described later in this section.
If you were in a 60‑day measurement cycle when you
left and you return during that same measurement cycle,
your hours will continue to be measured until the end of
that measurement cycle. All hours worked during that
measurement cycle will be used in the average‑hours‑
worked calculation. For example, if you have a 10‑day break
in service during the 60‑day measurement cycle, your
average hours will be calculated using the 50 days during
which you worked, rather than 60 days.
If you return to employment as a part‑time hourly or
temporary associate more than 30 days after leaving
during your first 52 weeks of employment, you will be
treated as a new hire for purposes of the 60‑day checks.
The measurement cycles will resume, with your date of
rehire being the first day of the first measurement cycle
(which is 59 days, as described above) that occurs after you
are rehired. The 60‑day measurement cycles will continue
until the end of the initial measurement period, which is
explained later in the next section.
INITIAL ELIGIBILITY CHECK FOR MEDICAL
BENEFITS CONDUCTED AT 52 WEEKS
If you are a part‑time hourly or temporary associate (other
than a part‑time or temporary associate in Hawaii, a part‑time
truck driver or a part‑time hourly pharmacist hired before
February 1, 2012) and you were not offered medical coverage
during the first 52 weeks of employment as described above,
your initial eligibility for medical benefits will be reviewed
based on your hours worked during your initial measurement
period. Your initial measurement period is the 52 consecutive
weeks beginning on your date of hire, during which your
average hours worked per week are reviewed.
If you work an average of at least 30 hours a week (24 hours
a week for part‑time nurse practitioners, part‑time hourly
pharmacists, and part‑time hourly and temporary associates
in the field supply chain) over the 52‑week review period
without a break in employment of greater than 13 weeks,
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you will become eligible for medical benefits at the close of
your initial measurement period. Specifically, your eligibility
for medical benefits will begin on the first day of the
second calendar month following your one‑year anniversary
date. For example, if your date of hire is April 16, 2021, your
average hours worked from that day through April 15, 2022
will be calculated. If you meet the average‑hours‑worked
requirement over this initial measurement period, your
coverage would begin June 1, 2022 (assuming you enroll in
a timely manner).
Initial medical coverage for associates who meet the
average‑hours‑worked requirement continues through
the end of the second calendar year immediately following
the calendar year that contains your date of hire. In the
example above, your coverage (if you enroll in a timely
manner) would continue through the end of 2023. You
would then be subject to annual eligibility checks, as
described below.
If you leave the company and are rehired
For purposes of the initial eligibility check, if you return
to employment as a part‑time hourly or temporary
associate within 13 weeks after leaving during your initial
measurement period, you will be treated as if you had not
left, for the remainder of the measurement period. All
hours worked during the measurement period will be used
in the average‑hours‑worked calculation. For example, if
you have a four‑week break in service during the 52‑week
measurement period, your average hours will be calculated
using the 48 weeks during which you worked, rather than
52 weeks. If you return to employment as a part‑time hourly
or temporary associate after 13 weeks or more, you will be
treated as a new hire.
If you terminate employment after the completion of the
initial measurement period and return to employment as
a part‑time hourly or temporary associate within 13 weeks
and before the end of the second calendar year immediately
following the calendar year that contains your date of
hire (for purposes of this paragraph, this is the “eligibility
period”), you will retain your previous eligibility status
through the end of the eligibility period. If you are rehired
after the eligibility period ends, your eligibility status will be
based on the annual eligibility check.
The following rules apply if you are enrolled in medical
benefits before you terminate employment, you return to
the company within 13 weeks, and you return during your
eligibility period:
• If you return during the same calendar year in which you
terminated, you will be enrolled automatically in your
previous coverage (or the most similar coverage offered
under the AMP). If you return within 30 days, your annual
deductible and out‑of‑pocket maximum under the AMP
for the calendar year in which you terminate will not be
reset. If you return after 30 days, your annual deductible
and out‑of‑pocket maximum will be reset and you will be
responsible for meeting the applicable deductible and
out‑of‑pocket maximum in their entirety.
• If you return during the calendar year immediately
following the calendar year in which you terminated, you
will be enrolled automatically in your previous coverage
(or the most similar coverage offered under the AMP).
Your annual deductible and out‑of‑pocket maximum will be
reset and you will be responsible for meeting the applicable
deductible and out‑of‑pocket maximum in their entirety.
You will have 60 days after resuming employment to drop
or otherwise change the coverage in which you were
automatically enrolled. If you return after 13 weeks, you
will be treated as a new associate and will be subject to the
60‑day and/or initial eligibility check for medical benefits
before you will be eligible.
ANNUAL ELIGIBILITY CHECK FOR
MEDICAL BENEFITS
If you are not eligible for medical coverage for the next
calendar year based on the initial eligibility checks as
described in the sections above (or you were not subject to
those rules) and you are classified as a part‑time hourly or
temporary associate (other than a part‑time or temporary
associate in Hawaii, a part‑time truck driver or a part‑time
hourly pharmacist hired before February 1, 2012), you will
be subject to an annual eligibility check to establish your
eligibility for medical benefits for the next calendar year.
You will also be subject to the annual eligibility check if you
were originally hired as a management or full‑time hourly
associate and were employed one year or more before
changing to part‑time hourly or temporary status.
The measurement period for the annual eligibility check
will be the 52 weeks preceding an annually designated
date in early October prior to each calendar year’s
Annual Enrollment. For example, the annual eligibility
check occurring in fall 2022 (for the 2023 calendar year)
will review your hours worked from October 5, 2021,
through October 4, 2022. If you meet the average hours
requirement (24 or 30 hours per week, depending on job
classification) over the 52‑week period, you will be eligible
to enroll in medical benefits during Annual Enrollment for
coverage during 2023.
If you do not meet the average weekly hours requirement
in the annual eligibility check, your medical coverage may
continue for a period of time, as described below under If you
do not meet the annual eligibility check for medical benefits.
If you have questions about the annual eligibility check, call
People Services at 800-421-1362.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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If you meet the annual eligibility check for
medical benefits
If you are a part‑time hourly or temporary associate who is
currently enrolled in medical coverage and you meet the
annual eligibility check in October, you will remain enrolled
in medical coverage for the remainder of the current year.
You will receive Annual Enrollment materials and be eligible
to enroll for medical benefits for the following year.
You will be subject to the annual eligibility check each
year to determine your eligibility for medical benefits for
subsequent years, provided you remain a part‑time hourly
or temporary associate.
If you do not meet the annual eligibility check for
medical benefits
If you are a part‑time hourly or temporary associate who
is currently enrolled in medical coverage, but you do not
meet the annual eligibility check in October, your eligibility
will continue through the end of the current calendar year,
in which the annual eligibility check occurred. You will
not be eligible for medical benefits for the following year
unless your job classification changes and you meet the
eligibility requirements based on your new classification.
You will receive a letter describing your options under the
Consolidated Omnibus Budget Reconciliation Act (COBRA)
to continue your medical coverage when the current calendar
year ends. (See the COBRA chapter for more information.)
You will be subject to the annual eligibility check each
year to determine your eligibility for medical benefits for
subsequent years, provided you remain a part‑time hourly
or temporary associate.
IF YOU TAKE TIME OFF DURING THE INITIAL
OR ANNUAL MEASUREMENT PERIOD
If you take any type of unpaid time off that is not an approved
leave of absence, as described below, the period of unpaid
leave will be used to calculate your average hours for the
initial and annual measurement periods (even if it is zero)
in which the absence occurs.
If your absence is an approved leave (including for jury duty,
Family and Medical Leave Act of 1993 [FMLA] leave, or
military leave), the calculation of your average hours worked
will be based on the number of weeks during the 52‑week
measurement period that you were not on the approved
leave. For example, if you take an approved leave during two
weeks of the 52‑week measurement period, your average
hours worked will be calculated over 50 weeks rather than 52.
If you leave the company and are rehired
For purposes of the annual eligibility checks, if you return
to employment as a part‑time hourly or temporary
associate within 13 weeks after leaving during your annual
measurement period, you will be treated as if you had not
left, for the remainder of the measurement period. All
hours worked during the measurement period will be used
in the average‑hours‑worked calculation. For example, if
you have a four‑week break in service during the 52‑week
measurement period, your average hours will be calculated
using the 48 weeks during which you worked, rather than
52 weeks. If you return to employment as a part‑time
hourly or temporary associate 13 weeks or more, you will be
treated as a new hire.
If you terminate employment after the completion of the
annual measurement period and return to employment as
a part‑time hourly or temporary associate within 13 weeks
and before the end of the calendar year immediately
following the calendar year that contains the latest annual
measurement period that you completed (for purposes
of this paragraph, this is the “eligibility period”), you will
retain your previous eligibility status through the end of the
eligibility period. If you are rehired within 13 weeks and after
the end of the eligibility period, your eligibility status will be
based on the annual eligibility check that corresponds with
the calendar year in which you return to employment.
If you are enrolled in medical benefits before you terminate
employment, you return to the company within 13 weeks,
and you return during your eligibility period, as defined
in the prior paragraph, you will be enrolled automatically
in your previous coverage (or the most similar coverage
offered under the Plan).
• If you return during the same calendar year in which you
terminated and within 30 days, your annual deductible and
out‑of‑pocket maximum under the AMP for the calendar
year in which you terminate will not be reset. If you return
after 30 days, your annual deductible and out‑of‑pocket
maximum will be reset and you will be responsible for
meeting the applicable deductible and out‑of‑pocket
maximum in their entirety.
• If you return during the calendar year immediately
following the calendar year in which you terminated,
your annual deductible and out‑of‑pocket maximum
will be reset and you will be responsible for meeting
the applicable deductible and out‑of‑pocket maximum
in their entirety.
You will have 60 days after resuming employment to drop
or otherwise change the coverage in which you were
automatically enrolled. If you return after 13 weeks, you
will be treated as a new associate and will be subject to the
60‑day and/or initial eligibility check for medical benefits
before you will be eligible.
NOTE: If you have questions about the calculation of
hours for the eligibility checks, call People Services at
800-421-1362.
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Dependent eligibility
If you are a management or full‑time hourly associate and are eligible for benefits under the Plan, you may also enroll all
eligible dependents as described below. For purposes of the Associate Benefits Book, the term “dependent” includes your
spouse/partner. If you are a part‑time hourly or temporary associate or a part‑time truck driver, and you are eligible for benefits
under the Plan, you may enroll only your dependent child in addition to yourself; you may not enroll your spouse/partner.
EMPLOYMENT CLASSIFICATION
ELIGIBLE DEPENDENTS (AS DEFINED BELOW)
• Management
• Full‑time hourly
• Part‑time hourly
• Temporary
• Part‑time truck driver
Can elect to cover:
• Spouse/partner
• Dependent child(ren)
Can elect to cover:
• Dependent child(ren)
But not spouse/partner
DEFINITIONS: ELIGIBLE DEPENDENTS
SPOUSE/PARTNER
• Your spouse, as long as you are not legally separated
• Your domestic partner (or “partner”), as long as you and your domestic partner:
DEPENDENT
CHILD(REN)
– Are in an exclusive and committed relationship similar to marriage and have been for at least 12 months
– Are not married to each other or anyone else
– Meet the age for marriage in your home state and are mentally competent to consent to contract
– Are not related in a manner that would bar a legal marriage in the state in which you live, and
– Are not in the relationship solely for the purpose of obtaining benefits coverage.
• Any other person to whom you are joined in a legal relationship recognized as creating some or all of the
rights of marriage in the state or country in which the relationship was created (also referred to as “partner”)
• Your dependent children through the end of the month in which the child reaches age 26. Your
dependent children are:
– Your natural children
– Your adopted children or children placed with you for adoption
– Your stepchildren or children of your eligible partner, provided however:
• Eligibility will end upon divorce or change in partner status, even if the child is under age 26
• Eligibility will end upon death of your spouse or partner, if the child is under 18, or
• Eligibility will continue until age 26 in the event of the death of your spouse or partner, if at the time
of death: i) the child has attained age 18, and ii) the child is enrolled in the Plan.
– Your foster children
– Someone for whom you have legal custody or legal guardianship, provided he or she is living as a member
of your household and you provide more than half of his or her support.
If an individual is your eligible dependent and ceases to satisfy
the definition of eligible dependent, that individual will no
longer be eligible for coverage under the Plan and you are
required to report the change. See When your dependent
becomes ineligible later in this chapter for information. If you
fail to report the change, you may be subject to the loss of
benefits and/or termination of employment.
If a court order requires you to provide medical, dental,
and/or vision coverage for your child, the child must be an
eligible dependent as defined above. For more information
on how the Plan handles a Qualified Medical Child Support
Order (QMCSO), see the Qualified Medical Child Support
Orders (QMCSO) section later in this chapter.
If you are enrolled for medical coverage in a local plan
option, HMO option, or the PPO Plan option, note that
these options do not offer out‑of‑network coverage and
do not offer nationwide provider networks. If you have an
eligible dependent living outside your medical plan option’s
service area, you may still enroll your eligible dependents,
but they will not have access to network providers in the
geographic area in which they live and may have access only
to emergency coverage. If you are unsure whether your
eligible dependent lives outside your AMP option’s service
area, call your health care advisor at the number on your
plan ID card.
IF YOUR CHILD IS INCAPABLE OF SELF-SUPPORT
If your child is enrolled in coverage under the AMP, you may
continue the child’s coverage beyond the end of the month
in which your child reaches age 26 if:
• The child is physically or mentally incapable of self‑support
and primarily dependent on you for legal support, and
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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• The child’s doctor provides written medical evidence of
• Child of your domestic partner/partner: State or
the child’s incapacity.
Additional coverage may be added if your child experiences
a valid status change event. For information regarding a
status change event, refer to the Status change events
section of this chapter.
Legal documentation for
dependent coverage
The Plan reserves the right to conduct a verification audit
of dependent eligibility. You may be required to provide
legal documentation to prove the eligibility of your
dependent. It is your responsibility to provide the written
documentation if requested to do so by the Plan. If you do
not provide necessary documentation in a timely manner,
the Plan has the right to cancel your dependent’s coverage.
It is your responsibility to notify the Plan of any changes in
your dependent’s eligibility.
Examples of valid documentation are as follows:
Spouse: Copy of marriage certificate or registration of
informal marriage through county or state. If your marriage did
not occur in the current calendar year, a copy of your jointly
filed federal tax return from the most recent tax season is
also required, or both of your tax returns if you file separately.
Domestic partner: Copy of domestic partner affidavit
(signed by you and your partner) or civil union or domestic
partner registration and one of the following documents as
proof of your relationship:
• Proof of shared residence via joint mortgage statement
or rental agreement
• Automobile title or registration showing joint ownership
of vehicle
• Joint checking, bank, or investment account statement*
• Joint credit account statement*
• Joint utility bill*
• Will and/or life insurance policy which designates the other
as the primary beneficiary
* These documents must be dated within 60 days of the
documentation request.
Children: Copy of the following documents, as applicable:
• Natural child or legally adopted child: State or
county‑issued birth certificate showing associate’s name
or signed court order.
• Stepchild: State or county‑issued birth certificate showing
parents’ names and copy of marriage certificate. If your
marriage did not occur in the current calendar year, a
copy of your jointly filed federal tax return from the most
recent tax season is also required, or both of your tax
returns if you file separately.
county‑issued birth certificate and proof of established
domestic partnership/partnership.
• Foster child: Signed letter from social service agent
confirming the child has been placed under your care.
• Child you have legal guardianship of: Signed court order.
NOTE: In certain cases you may be required to complete an
affidavit as well.
Dependents who are not eligible
Your dependent is not eligible for coverage under the Plan
if he or she is:
• Residing outside the U.S. (not applicable to optional
dependent life insurance, AD&D, critical illness, and
accident insurance, and not applicable if your dependent is
attending college full‑time outside the U.S.)
• Covered under an expatriate plan
• An undocumented immigrant
• Not an eligible dependent as defined under Dependent
eligibility on the previous page
• A Walmart associate already enrolled in coverage under
the Plan (not applicable to optional dependent life
insurance, AD&D, critical illness, and accident insurance)
• A dependent of another Walmart associate and already
enrolled in coverage under the Plan (not applicable to
optional dependent life insurance, AD&D, critical illness,
and accident insurance)
• Enrolled in Medicare Part D (applicable only to eligibility
for AMP options, including HMO and the PPO Plan options)
When your dependent
becomes ineligible
If your dependent is enrolled in coverage under the Plan and
becomes ineligible for coverage, you must notify People
Services at 800-421-1362 within 60 days from the date
your dependent becomes ineligible. If your dependent is
enrolled in medical coverage and you notify People Services
within this time frame, the Plan will send an election notice,
allowing your dependent to elect Consolidated Omnibus
Budget Reconciliation Act (COBRA) continuation coverage.
Your dependent’s election to enroll in COBRA coverage
must be received within 60 days from the date your
dependent loses coverage or the date of the election notice,
if later. See the COBRA chapter for more information.
Failure to notify the Plan by calling People Services at
800-421-1362 when your dependent becomes ineligible for
coverage may be considered an intentional misrepresentation
of material facts, which may result in your coverage being
canceled. If your dependent becomes ineligible for coverage
and you fail to notify the Plan by calling People Services, you
may be responsible for any charges mistakenly paid by the
Plan after the date that your dependent became ineligible.
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When you enroll for benefits
Once you have completed any applicable eligibility waiting
period and have met any other requirements, including the
actively‑at‑work requirement described below, you can
enroll for benefits during your initial enrollment period. Your
“initial enrollment period” is the first time you are eligible to
enroll. The timing of your initial enrollment period varies by
job classification and may change if your job classification
changes, provided you have not already had an “initial
enrollment period” while you were in the role that you
transfer from. For more information, see Enrollment and
effective dates by job classification later in this chapter and
refer to the chart that applies to your job classification. If you
do not enroll during your initial enrollment period, you will
not be able to enroll for the following benefits until the next
Annual Enrollment, unless you have a status change event, as
described in the Status change events section of this chapter:
• Medical, including HMO and PPO Plan options (subject to
the eligibility checks described in the section earlier in this
chapter titled Part-time hourly and temporary associates:
eligibility checks for medical benefits)
• Dental
• Vision
• Critical illness insurance
• Accident insurance
• Accidental death and dismemberment (AD&D)
• Short‑term disability enhanced plan (see important
exception regarding “late enrollees” immediately below)
• Long‑term disability (LTD) or truck driver LTD (see
important exception regarding “late enrollees”
immediately below)
You may add or drop optional associate life insurance and
optional dependent life insurance (or add coverage) at any
time. See important exception regarding “late enrollees”
immediately below.
Late enrollees. If you do not enroll in the short‑term disability
enhanced plan, the long‑term disability plan, truck driver
long‑term disability plan, optional associate life or optional
dependent life insurance during your initial enrollment
period and then elect coverage at a later date, as permitted
by the Plan, you will be considered a “late enrollee” and will
be subject to Proof of Good Health requirements before
coverage is approved and effective. If you enroll in optional
associate life or optional dependent life insurance during
your initial enrollment period for more than the guaranteed
amount or for the guaranteed amount and then increase
coverage for you or your spouse/partner, if eligible, at a
later date, you will also be subject to Proof of Good Health
Requirements. For more information, see Enrollment and
effective dates by job classification later in this chapter and
refer to the chart that applies to your job classification.
CHOOSING A COVERAGE LEVEL
If you enroll your eligible dependents in the Plan, they must
have the same coverage you elect for yourself. You may
change your coverage during Annual Enrollment or if you
have a status change event. See the Status change events
section later in this chapter.
Under the medical, dental, and vision plans, and critical
illness and accident insurance, you may elect one of the
following coverage levels:
• Associate only
• Associate + spouse/partner (except for part‑time
hourly associates, temporary associates, and part‑time
truck drivers)
• Associate + child(ren), or
• Associate + family (except for part‑time hourly associates,
temporary associates, and part‑time truck drivers).
CONFIRMING YOUR ENROLLMENT
Once you enroll in coverage, you can view your
confirmation statement on One.Walmart.com/Enroll.
If you see an error regarding the benefits you enrolled in,
immediately contact People Services at 800-421-1362.
YOUR PLAN ID CARD
When you enroll in any of the medical coverage options
available under the Associates’ Medical Plan (AMP), you
receive a plan ID card at your home address. Plan ID cards
for dependents whose address is different from yours are
sent directly to the dependent’s address. Your plan ID card
also serves as your pharmacy ID card.
If you enroll in any of the medical coverage options under
the AMP or the PPO Plan (if applicable) and you also enroll
in the Associates’ Dental Plan (the “dental plan”) and/or
the Associates’ Vision Plan (the “vision plan”), your plan ID card
will also serve as your dental ID card and/or your vision ID card.
If you enroll in an HMO and you also enroll in the dental plan
and/or the vision plan, you will receive separate ID cards for
the dental and/or vision plan.
If you enroll in the dental plan and/or the vision plan only,
you will receive separate ID cards for those plans. ID cards
will be mailed to your home address.
You can update your address or that of your dependents
who are under the age of 18 when you enroll online or at
any time on One.Walmart.com/Enroll. If your dependent
is age 18 or over, they need to contact People Services at
800-421-1362 to update their address.
When coverage is effective
See the Enrollment and effective dates by job classification
section of this chapter for more details about coverage
effective dates.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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If you are not at work on the day your coverage becomes
effective (including for a leave of absence) for medical,
dental, vision, critical illness insurance, accident insurance,
accidental death and dismemberment (“AD&D”) insurance,
Resources for Living, business travel accident insurance,
or company‑paid life insurance, your coverage is effective
on the first day you are “actively at work,” as defined below,
as long as you are enrolled for the benefit and have paid
the applicable premiums. No enrollment or premiums are
required for Resources for Living, business travel accident
insurance, short‑term disability basic, or company‑paid
life insurance.
If you are not at work for any reason (including for a leave
of absence) other than scheduled paid time off (PTO) on
the day your coverage becomes effective for optional
associate life insurance, optional dependent life insurance,
full‑time hourly short‑term disability basic or enhanced,
full‑time hourly and salaried long‑term disability (LTD) basic
or enhanced, or truck driver LTD insurance, your coverage
will be effective on the first day you are “actively at work,”
as defined below, as long as you are enrolled for the benefit
and have paid the applicable premiums.
“ACTIVE WORK” OR “ACTIVELY AT WORK”
For medical, dental, vision, critical illness insurance,
accident insurance, AD&D, and Resources for Living
coverage, “active work” (or “actively at work”) means you
are on active status and have reported to your first day of
work at the company, even if you are not at work the day
coverage is effective (for example, due to illness).
For company‑paid life insurance, optional associate life
insurance, optional dependent life insurance, and business
travel accident insurance, being actively at work means you
are on active status and not on a leave of absence.
For all types of disability coverage, being actively at work
means you have worked hours in the immediately preceding
pay period if you are an hourly associate or have earned
wages in the immediately preceding pay period if you are a
member of management.
AUTOMATIC REENROLLMENT
If you are currently enrolled in benefits and are eligible for
those same benefits during the following calendar year,
but do not actively enroll for those benefits during Annual
Enrollment, you and any dependents you cover will be
automatically reenrolled in the coverage options closest
to what you have currently. For more information, refer
to the Annual Enrollment materials provided to you and
posted online at One.Walmart.com. Call People Services at
800-421-1362 for information.
If you do not actively enroll during Annual Enrollment and
are enrolled automatically in coverage as described above,
you may not change this coverage except during Annual
Enrollment, unless you experience a status change event.
If you do not actively reenroll during Annual Enrollment, you
will be deemed to have consented to automatic reenrollment
and your payroll deductions will be adjusted accordingly.
If you leave the company and
are rehired
MANAGEMENT AND FULL-TIME
HOURLY ASSOCIATES
If you are enrolled for medical benefits before you terminate
employment and you return to the company within 13 weeks,
you will be enrolled automatically in your previous coverage
(or the most similar coverage offered under the Plan). If you
return within 30 days and in the same calendar year that
contains your termination date, your annual deductible and
out‑of‑pocket maximum under the AMP for the calendar year
in which you terminate will not be reset. If you return within
30 days but in a different calendar year than the calendar year
containing your termination date, you will be required to meet
the applicable deductible and out‑of‑pocket maximum in
their entirety. If you return after 30 days but within 13 weeks,
your annual deductible and out‑of‑pocket maximum will be
reset and you will be responsible for meeting the applicable
deductible and out‑of‑pocket maximum in their entirety.
You will have 60 days after resuming employment to drop
or otherwise change the coverage in which you were
enrolled automatically.
If you return after 13 weeks, you will be treated as a
new associate.
PART-TIME HOURLY AND
TEMPORARY ASSOCIATES
See the Part-time hourly and temporary associates:
eligibility checks for medical benefits section earlier in
this chapter for information about benefits if you leave the
company and are rehired.
Effective dates for benefits
under the Plan
The following Enrollment and effective dates by job
classification charts provide your coverage effective dates
if you enroll during your initial enrollment period and you
are actively at work, as defined earlier, on the coverage
effective date. If you terminate employment before
enrolling for benefits during your initial enrollment period,
you will not be eligible to enroll. Each benefit is subject to
specific terms and conditions. Please see the applicable
chapter of this Associate Benefits Book for details.
If you are a full‑time hourly, part‑time hourly, or temporary
associate in Hawaii, see the chapter titled Eligibility and
benefits for associates in Hawaii.
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Enrollment and effective dates by job classification
FULL‑TIME HOURLY ASSOCIATES (CONTINUED)
Includes pharmacists (except California pharmacists*), field supply chain, field supervisor positions in stores and clubs;
excludes Vision Center managers
NOTE: Don’t confuse the initial enrollment period with the coverage effective date. You must enroll in coverage prior to the coverage
effective date for most benefits.
Plan
• Medical
• HMO plans
• Dental
– Enrollment is for two full calendar years
• Vision
• Critical illness insurance
• Accident insurance
• AD&D
Enrollment periods and coverage effective dates
Initial enrollment period:
You must enroll in coverage between the date
of your first paycheck and the day prior to your
coverage effective date.
When coverage is effective:
Your coverage is effective the first day of the
calendar month during which your 89th day of
continuous full‑time employment falls.
If you elect coverage, your election
must remain in effect until the end
of the calendar year containing
the coverage effective date and
may not be changed until Annual
Enrollment for the next calendar
year or until you experience a status
change event, as described in the
Status change events section of
this chapter.
• Company‑paid life insurance
You are enrolled automatically on the first day of the calendar month during which
your 89th day of continuous full‑time employment falls.
• Resources for Living
• Business travel accident insurance
• Optional associate life insurance
• Optional dependent life insurance
You are enrolled automatically on your date of hire.
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day
prior to the first day of the calendar month during which your 89th day of continuous
full‑time employment falls
When coverage is effective:
If you enroll during your initial enrollment period:
• If you enroll for the guaranteed issue amount, coverage is effective on the later of
1) the date you enroll, or 2) the first day of the calendar month during which your
89th day of continuous full‑time employment falls.
• If you enroll for more than the guaranteed issue amount, coverage for you and your
spouse/partner is subject to Prudential’s approval. You will be required to provide
Proof of Good Health for yourself and/or your spouse/partner and may be required to
undergo a medical exam at your own expense. If approved, your coverage is effective
on the later of 1) the date Prudential approves your coverage or 2) the first day of the
calendar month during which your 89th day of continuous full‑time employment falls.
If you enroll after your initial enrollment period: You may enroll in, increase, or drop
coverage after the initial enrollment period and at any time during the year, but
your coverage (including an increase) is subject to Prudential’s approval. You will be
required to provide Proof of Good Health for yourself and/or your spouse/partner
and may be required to undergo a medical exam at your own expense. If approved,
your coverage is effective on the date Prudential approves your coverage.
(Continued on the next page)
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FULL‑TIME HOURLY ASSOCIATES (CONTINUED)
Includes pharmacists (except California pharmacists*), field supply chain, field supervisor positions in stores and clubs;
excludes Vision Center managers
NOTE: Don’t confuse the initial enrollment period with the coverage effective date. You must enroll in coverage prior to the coverage
effective date for most benefits.
Plan
Enrollment periods and coverage effective dates
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• Short‑term disability basic plan (not
available to associates who work in
California, Hawaii, New Jersey, and
Rhode Island; different coverage is
available in New York)
• Short‑term disability enhanced plan
(not available to associates who work
in California, Hawaii, New Jersey, and
Rhode Island; New York short‑term
disability enhanced plan is available in
New York)
• Long‑term disability (LTD) plan
(including enhanced benefits)
You are enrolled automatically on the 12‑month anniversary of your date of hire.
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day
prior to the first day of the calendar month during which your 89th day of continuous
full‑time employment falls.
When coverage is effective:
• If you enroll in coverage during your initial enrollment period: Coverage is
effective on the 12‑month anniversary of your date of hire.
• If you enroll in coverage after your initial enrollment period: Coverage is effective
12 months after the date you enroll in coverage at Annual Enrollment or, in the
case of a status change event, 12 months after the date of the event.
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day
prior to the first day of the calendar month during which your 89th day of continuous
full‑time employment falls.
When coverage is effective:
• If you enroll in coverage during your initial enrollment period: Coverage is
effective on the 12‑month anniversary of your date of hire.
• If you enroll in coverage after your initial enrollment period: Your coverage is
subject to Lincoln’s approval. You will be required to submit Proof of Good Health
and may be required to undergo a medical exam at your own expense.
– If you enroll in coverage following a status change event and are approved, your
coverage is effective on the later of 1) the first day of the pay period following the
date Lincoln approves your coverage or 2) the 12‑month anniversary of your date
of hire.
– If you enroll in coverage during Annual Enrollment and are approved, your
coverage will be effective the later of 1) January 1 of the following year or 2) the
12‑month anniversary of your date of hire.
– If you are not approved, you may be eligible to enroll during the next Annual
Enrollment or after a status change event but will be subject to the same Proof of
Good Health requirements.
* If you are classified as a “California pharmacist” in payroll systems, see the chart for management associates.
NOTE: Some benefits require you to meet the definition of active work. See the “Active work” or “actively at work” section in this
chapter for information.
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FULL‑TIME HOURLY VISION CENTER MANAGERS (CONTINUED)
NOTE: Don’t confuse the initial enrollment period with the coverage effective date. You must enroll in coverage prior to the coverage
effective date for most benefits.
Plan
• Medical
• HMO plans
• Dental
– Enrollment is for two full calendar years
• Vision
• Critical illness insurance
• Accident insurance
• AD&D
• Resources for Living
• Company‑paid life insurance
• Business travel accident insurance
• Optional associate life insurance
• Optional dependent life insurance
• Short‑term disability basic plan (not
available to associates in California,
Hawaii, New Jersey, and Rhode Island;
different coverage is available in
New York)
Enrollment periods and coverage effective dates
Initial enrollment period:
You must enroll in coverage between the
date of your first paycheck and the day
prior to the 60th day of employment,
measured from your date of hire.
When coverage is effective:
Your coverage is effective on your date
of hire.
If you elect coverage, your election must
remain in effect until the end of the
calendar year containing the coverage
effective date and may not be changed until
Annual Enrollment for the next calendar
year or until you experience a status change
event, as described in the Status change
events section of this chapter.
You are enrolled automatically on your date of hire.
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day
prior to the 60th day of employment, measured from your date of hire.
When coverage is effective:
If you enroll during your initial enrollment period:
• If you enroll for the guaranteed issue amount, coverage is effective on the date
you enroll.
• If you enroll for more than the guaranteed issue amount, coverage for you and your
spouse/partner is subject to Prudential’s approval. You will be required to provide
Proof of Good Health for yourself and/or your spouse/partner and may be required to
undergo a medical exam at your own expense. If approved, your coverage is effective
on the date Prudential approves your coverage.
If you enroll after your initial enrollment period: You may enroll in, increase or drop
coverage after the initial enrollment period and at any time during the year, but your
coverage (including an increase) is subject to Prudential’s approval. You will be required
to provide Proof of Good Health for yourself and/or your spouse/partner and may be
required to undergo a medical exam at your own expense. If approved, your coverage is
effective on the date Prudential approves your coverage.
You are enrolled automatically on your date of hire.
(Continued on the next page)
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
FULL‑TIME HOURLY VISION CENTER MANAGERS (CONTINUED)
NOTE: Don’t confuse the initial enrollment period with the coverage effective date. You must enroll in coverage prior to the coverage
effective date for most benefits.
Plan
Enrollment periods and coverage effective dates
• Short‑term disability enhanced plan
(not available to associates who work
in California, Hawaii, New Jersey, and
Rhode Island; New York short‑term
disability enhanced plan is available in
New York)
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day
prior to the 60th day of employment, measured from your date of hire.
When coverage is effective:
• If you enroll during your initial enrollment period: Coverage is effective your date
of hire.
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• Long‑term disability (LTD) plan
(including enhanced benefits)
• If you enroll in coverage after your initial enrollment period: Coverage is effective
12 months after the date you enroll in coverage at Annual Enrollment or, in the case
of a status change event, 12 months after the date of the event.
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day
prior to the 60th day following your date of hire.
When coverage is effective:
• If you enroll in coverage during your initial enrollment period: Coverage is
effective on your date of hire.
• If you enroll in coverage after your initial enrollment period: Your coverage is
subject to Lincoln’s approval. You will be required to submit Proof of Good Health
and may be required to undergo a medical exam at your own expense.
– If you enroll in coverage following a status change event and are approved, your
coverage is effective on the first day of the pay period following the date Lincoln
approves your coverage.
– If you enroll in coverage during Annual Enrollment and are approved, your
coverage will be effective January 1 of the following year.
– If you are not approved, you may be eligible to enroll during the next Annual
Enrollment or after a status change event but will be subject to the same Proof of
Good Health requirements.
NOTE: Some benefits require you to meet the definition of active work. See the “Active work” or “actively at work” section in this
chapter for information.
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PART‑TIME HOURLY AND TEMPORARY ASSOCIATES (CONTINUED)
NOTE: Don’t confuse the initial enrollment period with the coverage effective date. You must enroll in coverage prior to the coverage
effective date for most benefits.
Plan
• Medical*
• HMO plans
• Dental
– Enrollment is for two full
calendar years
• Vision
• Critical illness insurance
• Accident insurance
• AD&D
• Resources for Living
• Business travel accident insurance
Enrollment periods and coverage effective dates
Initial enrollment period:
If you are eligible during the first 52 weeks of employment as a result of working the
required number of hours in a 60-day measurement cycle: You must enroll in coverage
between the date you are first notified that you have met the eligibility requirements and
the day prior to the 60th day following notification. See the section titled Part-time hourly
and temporary associates: eligibility checks for medical benefits.*
If you are eligible as a result of the annual eligibility check that occurs at 52 weeks
of employment: You must enroll in coverage between the date following your 52‑week
anniversary and the day prior to the 60th day following the date of your 52‑week
anniversary.*
When coverage is effective:
If you are eligible during the first 52 weeks of employment as a result of working the
required number of hours in a 60-day measurement cycle: Your coverage is effective on
the first day of the month in which your 89th day of employment occurs after the date on
which the successful 60‑day measurement cycle began. See the section titled Part-time
hourly and temporary associates: eligibility checks for medical benefits.
If you are eligible as a result of the annual eligibility check that occurs at 52 weeks of
employment: Your coverage is effective on the first day of the second calendar month
following your 52‑week anniversary date.
If you elect coverage, your election must remain in effect until the end of the calendar year
containing the coverage effective date and may not be changed until Annual Enrollment
for the next calendar year or until you experience a status change event, as described in the
Status change events section of this chapter.
* To be eligible for medical coverage, part‑time hourly and temporary associates must work the
required number of hours and pass one of the eligibility checks described under Part-time
hourly and temporary associates: eligibility checks for medical benefits earlier in this chapter.
Part‑time hourly pharmacists hired before February 1, 2012, are exempt from this requirement.
You are enrolled automatically on your date of hire.
(Continued on the next page)
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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PART‑TIME HOURLY AND TEMPORARY ASSOCIATES (CONTINUED)
NOTE: Don’t confuse the initial enrollment period with the coverage effective date. You must enroll in coverage prior to the coverage
effective date for most benefits.
Plan
Enrollment periods and coverage effective dates
• Optional associate life insurance
• Optional dependent life insurance
Initial enrollment period:
If you are eligible during the first 52 weeks of employment as a result of working the
required number of hours in a 60-day measurement cycle: You must enroll in optional
associate or optional dependent life insurance coverage between the date you are first
notified that you have met the eligibility requirements and the day prior to the 60th day
following notification.
If you are eligible as a result of the annual eligibility check that occurs at 52 weeks of
employment: You must enroll in coverage between the date following your 52‑week
anniversary and the day prior to the 60th day following the date of your 52‑week anniversary.
When coverage is effective:
For purposes of determining the effective date of your optional life insurance, you will
need to refer to the discussion of eligibility for medical benefits. If you become eligible
for medical benefits before your first 52‑week anniversary because you worked the
required number of hours in a 60‑day measurement period, the effective date of your
medical benefits is the “applicable date” for determining the effective date for optional
life insurance.
If you did not become eligible for medical coverage before your 52‑week anniversary,
the “applicable date” for determining the effective date for optional life insurance is the
first day of the second calendar month following your 52‑week anniversary.
If you enroll during your initial enrollment period:
• If you enroll for the guaranteed issue amount, coverage is effective on the later of
1) the date you enroll, or 2) the “applicable date.”
• If you enroll for more than the guaranteed issue amount, your coverage is subject to
Prudential’s approval. You will be required to provide Proof of Good Health and may be
required to undergo a medical exam at your own expense. If approved, your coverage
is effective on the later of 1) the date Prudential approves your coverage or 2) the
“applicable date.”
If you enroll after your initial enrollment period: You may enroll in, increase or drop
coverage after the initial enrollment period and at any time during the year, but your
coverage (including an increase) is subject to Prudential’s approval. You will be required
to provide Proof of Good Health and may be required to undergo a medical exam at your
own expense. If approved, your coverage is effective on the date Prudential approves
your coverage.
Part‑time hourly and temporary associates may only cover their eligible dependent children and may not cover their spouse/
partners. Disability coverage and company‑paid life insurance are not available to part‑time hourly and temporary associates.
NOTE: Some benefits require you to meet the definition of active work. See the “Active work” or “actively at work” section in this
chapter for information.
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PART‑TIME TRUCK DRIVERS
NOTE: Don’t confuse the initial enrollment period with the coverage effective date. You must enroll in coverage prior to the coverage
effective date for most benefits.
Plan
• Medical
• HMO plans
• Dental
– Enrollment is for two full calendar years
• Vision
• Critical illness insurance
• Accident insurance
• AD&D
• Resources for Living
• Business travel accident insurance
• Optional associate life insurance
• Optional dependent life insurance
Enrollment periods and coverage effective dates
Initial enrollment period:
You must enroll in coverage between the
date of your first paycheck and the day
prior to your coverage effective date.
When coverage is effective:
Your coverage is effective the first day
of the calendar month during which your
89th day of continuous employment falls.
If you elect coverage, your election
must remain in effect until the end
of the calendar year containing the
coverage effective date and may not
be changed until Annual Enrollment
for the next calendar year or until you
experience a status change event, as
described in the Status change events
section of this chapter.
You are enrolled automatically on your date of hire.
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the
day prior to the first day of the calendar month during which your 89th day of
continuous full‑time employment falls.
When coverage is effective:
If you enroll during your initial enrollment period:
• If you enroll for the guaranteed issue amount, coverage is effective on the later
of 1) the date you enroll, or 2) the first day of the calendar month during which
your 89th day of continuous employment falls.
• If you enroll for more than the guaranteed issue amount, your coverage is subject
to Prudential’s approval. You will be required to provide Proof of Good Health and
may be required to undergo a medical exam at your own expense. If approved,
your coverage is effective on the later of 1) the date Prudential approves your
coverage or 2) the first day of the calendar month during which your 89th day of
continuous employment falls.
If you enroll after your initial enrollment period: You may enroll in, increase or
drop coverage after the initial enrollment period and at any time during the year,
but your coverage (including an increase) is subject to Prudential’s approval. You
will be required to provide Proof of Good Health and may be required to undergo a
medical exam at your own expense. If approved, your coverage is effective on the
date Prudential approves your coverage.
Part‑time truck drivers are not subject to the benefits eligibility checks described earlier in this chapter.
Part‑time truck drivers may only cover their eligible dependent children and may not cover their spouses/partners.
Disability coverage and company‑paid life insurance are not available to part‑time truck drivers.
NOTE: Some benefits require you to meet the definition of active work. See the “Active work” or “actively at work” section in this
chapter for information.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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MANAGEMENT ASSOCIATES
Includes management trainees, California pharmacists,* and full‑time truck drivers
NOTE: Don’t confuse the initial enrollment period with the coverage effective date. You must enroll in coverage prior to the coverage
effective date for most benefits.
Plan
• Medical
• HMO plans
• Dental
– Enrollment is for two full calendar years
• Vision
• Critical illness insurance
• Accident insurance
• AD&D
• Resources for Living
• Company‑paid life insurance
• Business travel accident insurance
• Short‑term disability plan**
• Optional associate life insurance
• Optional dependent life insurance
• Long‑term disability (LTD) plan
(including enhanced benefits)
• Truck driver LTD plan (including
enhanced benefits)
Enrollment periods and coverage effective dates
Initial enrollment period:
You must enroll in coverage between the
date of your first paycheck and prior to
the 60th day of employment, measured
from your date of hire.
When coverage is effective:
Your coverage is effective on your date
of hire.
If you elect coverage, your election must
remain in effect until the end of the
calendar year containing the coverage
effective date and may not be changed until
Annual Enrollment for the next calendar
year or you experience a status change
event, as described in the Status change
events section of this chapter.
You are enrolled automatically on your date of hire.
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and prior to the
60th day of employment, measured from your date of hire.
When coverage is effective:
If you enroll during your initial enrollment period:
• If you enroll for the guaranteed issue amount, coverage is effective on the date
you enroll.
• If you enroll for more than the guaranteed issue amount, coverage for you and
your spouse/partner is subject to Prudential’s approval. You will be required to
provide Proof of Good Health for yourself and/or your spouse/partner and may
be required to undergo a medical exam at your own expense. If approved, your
coverage is effective on the date Prudential approves your coverage.
If you enroll after your initial enrollment period: You may enroll in, increase, or drop
coverage after the initial enrollment period and at any time during the year, but
your coverage (including an increase) is subject to Prudential’s approval. You will be
required to provide Proof of Good Health for yourself and/or your spouse/partner
and may be required to undergo a medical exam at your own expense. If approved,
your coverage is effective on the date Prudential approves your coverage.
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day
prior to the 60th day of employment, measured from your date of hire.
When coverage is effective:
• If you enroll in coverage during your initial enrollment period: Coverage is
effective on your date of hire.
• If you enroll in coverage after your initial enrollment period: Your coverage is
subject to Lincoln’s approval. You will be required to submit Proof of Good Health
and may be required to undergo a medical exam at your own expense.
– If you enroll in coverage following a status change event and are approved, your
coverage is effective on the first day of the pay period following the date Lincoln
approves your coverage.
– If you enroll in coverage during Annual Enrollment and are approved, your
coverage will be effective January 1 of the following year.
– If you are not approved, you may be eligible to enroll during the next Annual
Enrollment or after a status change event but will be subject to the same Proof of
Good Health requirements.
* Pharmacists who work in California and have the designation of “California pharmacist” in payroll systems are eligible for the benefits
listed here for management associates.
** The salaried and truck driver short‑term disability plans are not covered by ERISA and are not part of the Associates’ Health and
Welfare Plan.
NOTE: Some benefits require you to meet the definition of active work. See “Active work” or “actively at work” in this chapter
for information.
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Paying for your benefits
When you enroll in the Plan, payroll deductions for the
premium amounts are withheld from your paycheck to
pay for the coverage you have elected. The first paycheck
after your effective date will generally reflect deductions
for each day you had coverage during that pay period. If a
pay period spans two calendar years, your deductions will
reflect the amount for the prior year through December
31 and the new amount for the new year, prorated for the
number of days covered from January 1 until the end of
the pay period.
Your payroll deductions for benefits in any pay period are
for the cost of coverage provided to you during that pay
period. So, if you are paid biweekly (every other week), your
deductions pay for coverage for the two‑week period that is
the pay period. For example, if a pay period runs from April
1 through April 14, the payroll deductions for benefits taken
for that payroll period are deductions for coverage for that
pay period, assuming all premiums are current through the
end of that pay period. If you are behind on your premiums
for any reason, you will have benefits coverage only through
the date to which your premiums are current. Deductions
are based on biweekly pay periods (except in Rhode Island,
which has weekly pay periods).
If your payroll deductions are not sufficient to pay any
portion of a premium due, you are responsible for paying
any unpaid premiums to the extent the premiums would
have been paid if withheld as a payroll deduction. If you
owe premiums for benefits coverage, any check issued by
the company (e.g., paid time off, incentive, etc.), including
during or after a leave of absence, will have premiums
deducted on an after‑tax basis, as permitted by law.
Be sure to check your statement of earnings and deductions
on your pay stub to verify that the proper deductions
are being taken. You can view your paycheck stub the
Monday before payday by going to Online Paystub on
One.Walmart.com. If you believe the coverage or deductions
are not correct on your pay stub, call People Services
immediately at 800-421-1362. Requests for a review of
premiums paid are considered if submitted within one
year from the date of a possible overpayment. A premium
reconciliation up to a maximum of one year will be completed.
Many of your Plan benefits are paid for with pretax dollars,
which means your payroll deductions for coverage are
deducted from your paycheck before federal and, in most
cases, state taxes are withheld. Because Social Security
taxes are not withheld on any pretax dollars you spend for
benefits, amounts you pay for benefits with pretax dollars
are not counted as wages for Social Security purposes.
As a result, your future Social Security benefits may be
reduced somewhat.
If you are enrolled in the Saver Plan, you may also be eligible
to contribute to a health savings account on a pretax basis. See
the Health savings account (HSA) chapter for information.
Deductions for premiums or contributions that are past due
or for retroactive elections generally must be made on an
after‑tax basis.
WHEN SPECIAL ARRANGEMENTS ARE
NECESSARY TO MAINTAIN COVERAGE
If your payroll deductions are not sufficient to pay any
portion of a premium due, you are responsible, regardless of
your job status, for making arrangements to pay any unpaid
premiums to the extent the premiums would have been paid
if withheld as payroll deductions. These terms apply to the
following benefits:
• Medical
• Dental
• Vision
• Critical illness insurance
• Accident insurance
• Accidental death and dismemberment (AD&D)
• Optional associate life insurance
• Optional dependent life insurance
Your premium payments for coverage during a pay period
are due by the close of that pay period and will be made
on an after‑tax basis. Your failure to make your premium
payments by the due date may result in your coverage being
canceled due to nonpayment of premiums.
To avoid interruption or cancellation of coverage,
premium payments can be made in advance through the
automated system with a VISA, MasterCard, American
Express, or Discover credit or debit card by logging into
the payment portal on One.Walmart.com/Enroll. You can
also call People Services at 800-421-1362 and say “make
a payment.” To confirm the premium amount owed, call
People Services.
Payments of premiums may also be made by check or
money order and should be made payable to Associates’
Health and Welfare Trust and mailed to:
Walmart People Services
P.O. Box 1039
Department 3001
Lowell, Arkansas 72745
To ensure proper credit when you send payment, include
your name and WIN number on your payment. Please allow
10‑14 days for processing.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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“Tobacco free” means that you (and/or your covered
spouse/partner) do not use tobacco in any form —
cigarettes, cigars, pipes, snuff, or chewing tobacco.
For purposes of establishing tobacco‑free rates,
being “tobacco free” also means that you do not use
e‑cigarettes or any such nicotine‑delivery devices.
You will be asked to attest to your tobacco use at your
initial enrollment, to determine your eligibility for
tobacco‑free rates for your initial eligibility period,
and each year at Annual Enrollment, to determine
your eligibility for tobacco‑free rates for the next
calendar year.
The statement below is shown on the screen when you
enroll for benefits and answer the questions regarding
tobacco use:
“Our expectation is that you will apply for or enroll in benefits
using correct and accurate information. If not, you may be
subject to the loss of benefits and/or loss of employment.”
To review the company’s policy about intentional
dishonesty, please refer to the Statement of Ethics, which
can be found on One.Walmart.com. If we receive a report
of abuse, we will conduct an ethics investigation.
Please note that your eligibility for tobacco‑free rates can
be established only at your initial enrollment and at Annual
Enrollment. If you become tobacco‑free during the year,
you will not become eligible for tobacco‑free rates until the
following calendar year.
The company offers the Quit Tobacco program at no cost to
all associates. For information, see Quit Tobacco program in
The medical plan chapter.
IMPORTANT
If you are a first‑time enrollee, you must
actively complete an online enrollment
session at One.Walmart.com/Enroll to
receive tobacco‑free rates.
If your coverage is canceled due to nonpayment of premiums:
• If you are an active associate, you will not be able to
enroll again until the next Annual Enrollment or until
you have a valid status change event. However, you may
enroll in optional life insurance at any time, provided
you remain eligible.
• If you are on a leave of absence and return to active
work within one year of the first day of the leave, you will
be enrolled for the same coverage (or the most similar
coverage offered under the Plan). Your coverage will be
effective the first day of the pay period that you return to
active work.
• If you are on a leave of absence and return to active
work after more than one year after the first day of the
leave, you will be considered a newly eligible associate
and will be required to meet any applicable eligibility
requirements before you may enroll in coverage.
TAX CONSEQUENCES OF PARTNER BENEFITS
Partners generally do not qualify as spouses or dependents
for federal income tax purposes. Therefore, the value of
company‑provided medical (including the HRA) coverage
that relates to your partner, or your partner’s children, is
generally considered imputed income and taxable to you.
This value is subject to change from year to year as the
underlying benefit values change. Tax and other withholdings
are made from your paycheck and the value of those
benefits is included in your Form W‑2. During any period
in which partner benefits that have an imputed income are
maintained by you but you are not receiving a paycheck from
the company, the company reserves the right to collect your
portion of the FICA tax liability directly from you.
These rules do not apply if your partner satisfies the
requirements to be considered your tax dependent under
the Internal Revenue Code.
Tobacco rates
You can receive lower tobacco‑free rates for medical
and prescription drug coverage, optional associate life
insurance, optional dependent life insurance for a spouse,
and critical illness insurance if:
• You and/or a covered spouse/partner do not use tobacco
and are considered to be “tobacco free,” or
• You and/or a covered spouse/partner use tobacco and
you complete participation in a quit‑tobacco program of
your choice between the time of Annual Enrollment and
December 31, 2022. Alternatively, if you call Walmart’s
Quit Tobacco program at 866-577-7169, the program
will work with you (and, if you wish, your doctor) to find a
program that is right for you.
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Continuing benefit coverage if you
go on a leave of absence
While you are on a Family Medical Leave Act (FMLA) leave,
personal leave, or military leave, you retain any medical,
dental, vision, critical illness insurance, accident insurance,
optional associate life, optional dependent life, AD&D, and
Resources for Living coverage that you had on the day
immediately preceding the first day of the leave. Coverage
generally is maintained on the same terms and conditions as
if you had continued to work during the leave.
During your leave, you are responsible for paying any unpaid
premiums to the extent the premiums would have been
paid if withheld as a payroll deduction. See When special
arrangements are necessary to maintain coverage earlier in
this chapter for details.
If you cancel your coverage during your FMLA, personal or
military leave and return to work, you may contact People
Services at 800-421-1362 within 60 days of returning to
work to reinstate your coverage. See the If you go on a
leave of absence section in the respective chapters for each
of the above‑named benefits to learn more.
Decisions about leaves of absence are made by the
company, not the Plan.
Contact a member of your management team or Sedgwick
for additional information about FMLA, personal or military
leave, or refer to the company’s Leave of Absence Policy on
One.Walmart.com for specific information. You may also
contact your personnel representative if you have questions
about the FMLA, personal or military leave policy.
PAYING FOR BENEFITS WHILE ON
A LEAVE OF ABSENCE
To continue benefit coverage while on a leave of absence,
you must pay your premiums on an after‑tax basis. For
details on making payments while on a leave of absence,
refer to When special arrangements are necessary to
maintain coverage earlier in this chapter.
If you are on a leave of absence and you owe premiums for
benefits coverage, any check issued by the company (e.g.,
paid time off, incentive, etc.) will have premiums deducted
on an after‑tax basis, as permitted by law.
Continuing benefit coverage
while disabled
If you are a salaried associate or truck driver receiving
short‑term disability benefits, please see the Salaried
short-term disability plan or the Truck driver short-term
disability plan chapter for information about continuing
benefit coverage while disabled.
If you are receiving disability benefits and wish to continue
your coverage under other benefits offered under the Plan,
this chart describes how your coverage costs are handled:
TO MAINTAIN COVERAGE UNDER THESE BENEFITS
• Medical
• Dental
• Vision
• Critical illness insurance
• Accident insurance
• Optional associate life
• Optional dependent life
• AD&D
WHILE YOU ARE RECEIVING…
Full-time hourly
short-term
disability (except
for associates who
work in CA, HI, NJ,
NY, and RI)
Full-time hourly
short-term
disability for
associates who
work in CA, HI,
NJ, NY, or RI
• Full-time hourly
and salaried
long-term
disability
• Truck driver
long-term
disability
Your premiums for the coverage listed
above will be deducted from your
short‑term disability benefit checks
(issued through the company payroll
system).
NOTE: You are not required to pay
short‑term disability enhanced plan
or long‑term disability plan premiums
from any short‑term disability benefit
payments you receive.*
Your premiums for the coverage
listed above will not be deducted
from your short‑term disability
benefit checks because they are not
issued through the company payroll
system. You must make premium
payments each pay period or risk
cancellation of your benefits.
NOTE: You are not required to pay
short‑term disability enhanced plan
or long‑term disability plan premiums
from any short‑term disability benefit
payments you receive.*
Your premiums for the coverage
listed above will not be deducted
from your long‑term disability
benefit checks because they are not
issued through the company payroll
system. You must make premium
payments each pay period or risk
cancellation of your benefits.
NOTE: You are not required to pay
short‑term disability enhanced plan
or long‑term disability plan premiums
from any long‑term disability benefit
payments you receive.*
* If you receive any other earnings, including bonuses, through
the company payroll systems while you are receiving disability
benefits, your applicable disability premiums will be withheld
from those payments.
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Status change events
Certain benefits can be changed at any time during the
year, but others (generally those you pay for on a pretax
basis and in the case of the Plan, most disability benefits)
can be changed only during Annual Enrollment or if you
have a status change event, as follows:
• Optional associate life insurance and optional dependent
life insurance can be added or dropped at any time.
• The AMP options (including the HMO and PPO Plan
options), dental, vision, AD&D, critical illness insurance,
accident insurance, short‑term disability enhanced, New
York short‑term disability enhanced, long‑term disability,
and truck driver long‑term disability can be changed only
during Annual Enrollment unless you have a status change
event. (Disability benefits are not paid for on a pretax basis.)
Federal tax law generally requires that your pretax benefit
choices remain in effect for the entire calendar year for
which the choice was made, except in the case of life events
or certain other events described in federal regulations.
In this SPD, we use the term “status change events” to
mean the full range of circumstances described in federal
regulations that allow you to change your pretax elections.
This does not apply to pretax contributions to a health savings
account, which can be changed at any time.
You may make certain coverage changes if you experience
a status change event. A status change event for purposes
of this SPD is a life event or other event listed in federal
regulations that allows you to make changes to your
coverage outside of annual or initial enrollment. Any change
you make in response to a life event must be directly related
to the impact of the event on your benefits and impact
eligibility. In other words, there must be a logical relationship
between the life event and the change you request and
the life event that occurs must also make an individual
eligible or ineligible for coverage. This is referred to in
federal regulations as “the consistency rule.” For example,
if you (the associate) and your spouse divorce, your spouse
loses eligibility for benefits under the Plan on the date
of the divorce but your other dependents remain eligible
for benefits under the Plan. Therefore, you can only drop
coverage for your spouse. Changing another dependent’s
coverage due to this life event would not be permitted.
When you have a status change event (including a life event
or the loss or gain of other coverage as described below),
any changes to your coverage must be made within 60 days
from the date of the event.
Status change events include the following life events:
• Events that change your marital status:
– Marriage
– Death of your spouse
– Divorce (including the end of a common‑law marriage
in states where a divorce decree is required to end a
recognized common‑law marriage)
– Annulment, or
– Legal separation.
• Events that change your domestic partnership status:
– Commencement of domestic partnership
– Termination of domestic partnership, or
– Death of your domestic partner.
• Events that change the status of a legal relationship with
a person other than a spouse or domestic partner, as
specified in the definition of partner:
– Commencement of legal relationship
– Termination of legal relationship, or
– Death of the other person to whom you are joined in
legal relationship.
• Events that change the number of your dependents:
– Birth
– Adoption
– Placement for adoption
– Death of a dependent
– Gain of legal custody of a dependent
– Loss of legal custody of a dependent for whom you have
previously been awarded legal custody or guardianship
by a judge
– Your paternity test result
– A dependent loses eligibility, such as at the end of the
month in which the dependent reaches age 26, or
– You receive valid documentation establishing the
eligibility of a dependent previously deemed ineligible.
• Employment changes experienced by you, your spouse/
partner or your dependent:
– Going on or returning from an approved leave of
absence
– Gain or loss of coverage due to starting or ending
employment
– A change in work location that affects your medical
coverage. If the change affects your medical coverage
options (such as if a new HMO, local plan, or PPO
Plan option is offered), you will have 60 calendar days
from your transfer to submit a request to change
your coverage. If you transfer work locations where
your medical benefits are affected and do not submit
a request, you will automatically be enrolled in a
predetermined plan.
Status change events also include changes in cost or coverage
and other events, as detailed in the following section.
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GAIN OF COVERAGE
• Gain of coverage under any other employer plan.
• If you are a part‑time hourly or temporary associate and
your hours are reduced such that you work an average
of less than 30 hours per week (regardless of whether
the reduction in hours affects your eligibility for medical
benefits) and you intend to enroll in another plan that
provides minimum essential coverage that is effective no
later than the first day of the second month following the
month that your medical coverage under the Plan would
end, you may drop coverage in the AMP (including an
HMO or PPO Plan option).
• Additions/improvements of a benefit option under this Plan.
• Eligibility under a governmental plan: If you or your
eligible dependents gain eligibility under a governmental
plan (other than Medicare, Medicaid, TRICARE, or a state
children’s health insurance plan), you cannot drop the
AMP (including an HMO or PPO Plan option), accident
insurance, or critical illness insurance coverage except
during Annual Enrollment.
• If you are eligible for a Special Enrollment Period to enroll
in a qualified health plan through a Health Insurance
Marketplace, or you seek to enroll in a qualified health plan
through a Marketplace during the Marketplace’s annual
enrollment, as described in Changes in your coverage
following a status change event, you can drop coverage
in the AMP (including an HMO or PPO Plan option) in
accordance with rules set forth by the Department of
Health and Human Services. You and any dependent who
cease coverage under the Plan must provide evidence of
your enrollment rights and state that you intend to enroll
in a qualified health plan through a Marketplace effective
no later than the day immediately following the last day of
your coverage under the AMP (including an HMO or PPO
Plan option).
LOSS OF COVERAGE
• Loss of coverage under any other employer plan.
• Reduction of coverage under this Plan.
• Significant loss of coverage, such as if an HMO plan in your
area discontinues service. The Plan determines when a
significant loss of coverage has occurred.
• If you or your eligible dependents lose coverage under a
governmental plan including Medicaid or a state children’s
health insurance plan, an educational institution’s plan, or
a tribal government plan, you can add coverage under the
AMP (including an HMO or PPO Plan option), accident
insurance, or critical illness insurance within 60 days of the
loss of coverage. (This does not apply to loss of coverage
under a Health Insurance Marketplace plan.)
• You may add medical, dental, or vision coverage for you
and/or your eligible dependents if:
– You originally declined coverage because you and/or
your dependents had COBRA coverage and that
COBRA coverage has ended (nonpayment of premiums
is not sufficient for this purpose)
– You and/or your dependents had non‑COBRA medical
coverage and the other coverage has terminated due to
your loss of eligibility, or
– Employer contributions toward other coverage have
terminated.
CHANGE IN COST
If the cost of coverage under this Plan or another Plan
changes, you may be able to change your election
accordingly. The Plan determines when a significant change
in cost has occurred and what election changes you may
make in response.
LEGAL ORDER
If an order resulting from a divorce, legal separation,
annulment, or change in legal custody (including a Qualified
Medical Child Support Order — See Qualified Medical Child
Support Orders (QMCSO) later in this chapter) requires
you to provide medical, dental, and/or vision coverage for
your eligible dependent child, you may add coverage for
your eligible dependent child (and yourself, if you are not
already covered). If the order requires your spouse, former
spouse, or other person to provide medical, dental, and/or
vision coverage for your dependent child, and that other
coverage is in fact provided, you may drop coverage for the
dependent child.
MEDICARE OR MEDICAID ENTITLEMENT
If you or your eligible dependents are enrolled in the AMP
(including an HMO or PPO Plan option), accident insurance,
or critical illness insurance, you can drop that coverage
if you or your dependents become entitled to Medicare
or Medicaid benefits or coverage under a state children’s
health insurance plan. If you or your eligible dependents
become eligible for assistance under Medicaid or a state
children’s health insurance plan to help you pay for Plan
coverage, you must request coverage under the Plan within
60 days of becoming eligible for assistance.
For information about circumstances in which you
may change your benefits, contact People Services at
800-421-1362.
CHANGES IN YOUR COVERAGE FOLLOWING A
STATUS CHANGE EVENT
When you have a status change event, you must request
your change within 60 days from the date of the event.
Unless otherwise provided in the Plan, if you add a spouse or
partner or other eligible dependent due to a life event, each
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person must individually meet any applicable benefit waiting
period (for example, for transplant coverage or weight loss
surgery) and will be subject to applicable Plan limitations. If
you change medical plans due to a status change event, your
annual deductible and out‑of‑pocket maximum will reset,
and you will be responsible for meeting the new deductible
and out‑of‑pocket maximum in their entirety. If you change
from the Contribution Plan to another plan, your HRA
balance under the Contribution Plan will be forfeited. See
The medical plan chapter for information.
If you are covered as a dependent and move to coverage
as an associate during the Plan year, you will generally not
receive credit under the AMP for expenses incurred prior
to the date of the change. However, if you are covered as
a dependent and you experience a qualifying event that
affects your status as a dependent and makes you eligible
for your own continuation coverage under COBRA, you
will receive credit toward your deductibles and out‑of‑
pocket maximum under the AMP for expenses incurred as a
covered dependent. You will also receive credit toward any
waiting periods.
The Plan reserves the right to request additional necessary
documentation to show proof of a status change event.
HIPAA SPECIAL ENROLLMENT FOR
MEDICAL COVERAGE
• To request special enrollment or obtain more information,
refer to the information earlier in this chapter regarding
status change events or contact People Services at
800-421-1362.
HOW TO CHANGE YOUR ELECTIONS DUE TO
A STATUS CHANGE EVENT
You can make changes online within 60 days of the event on
One.Walmart.com/Enroll for life event status changes due to:
• Adoption
• Birth
• Commencement of domestic partnership
• Commencement of legal relationship with a person other
than your spouse or domestic partner
• Death of spouse/partner
• Divorce or legal separation
• Gain or loss of legal custody
• Gain or loss of coverage by you, your dependent(s), or your
eligible spouse/partner
• Going on leave of absence
• Marriage
• Returning from leave of absence
• Special enrollment period
• Termination of domestic partnership, or
Under the Health Insurance Portability and Accountability
Act of 1996 (HIPAA), you also may have a right to a special
enrollment in medical coverage under the Plan if you lose
other coverage or acquire a dependent. These events are
described in the lists of status change events and include:
• Termination of legal relationship with a person other than a
spouse or domestic partner.
For all other types of status changes, call People Services at
800-421-1362.
• If you decline enrollment for yourself or your dependents
because of other health insurance or group health
plan coverage, you may be able to enroll yourself, and
if you choose, your dependents in this Plan if you or
your dependents lose eligibility for that coverage (or if
the employer stops contributing toward your or your
dependents’ other coverage). You must request enrollment
within 60 days after your or your dependents’ other
coverage ends (or after the employer stops contributing
toward the other coverage).
• If you have a new dependent as a result of marriage, birth,
adoption, or placement for adoption, you may be able to
enroll yourself and/or your eligible dependents. You must
request enrollment within 60 days.
• If you or a dependent is no longer eligible for coverage
under Medicaid or a state children’s health plan, or you
or a dependent becomes eligible for assistance for Plan
coverage under Medicaid or a state children’s health
plan, you must request enrollment within 60 days of the
prior coverage terminating or your becoming eligible for
assistance. Such coverage will be effective upon the date
you enroll in the Plan.
If your status change event is the birth of a dependent, the
Plan will accept provider billing charges related to the birth
as notice that the newborn is to be added as a dependent
under your coverage, so long as the charges are submitted
within 60 days of the birth.
If you are seeking to add a dependent as a result of
marriage, commencement of a domestic partnership, or
commencement of a legal relationship with a person other
than a spouse or domestic partner, but the individual to be
added as a dependent dies before you have provided notice
of the status change event, the individual will not be added
to your coverage as a dependent.
Changes to your coverage are effective on the event
date or on the day after the status change event date. If a
change is made due to your unpaid leave of absence, the
change is effective as of the effective date of your leave
of absence. This does not apply to optional associate life
insurance, optional dependent life insurance, short‑term
disability enhanced plan coverage, long‑term disability, or
truck driver long‑term disability; see the Enrollment and
effective dates by job classification charts in this chapter
for information about effective dates.
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If your status change results in an increase in your coverage
costs, such as if you change from associate‑only coverage
to associate + dependent coverage, the increased charge
will be deducted from your pay after you notify People
Services of your status change event and will be retroactive
to the effective date of your new coverage. These
retroactive deductions are made on an after‑tax basis.
If you do not notify People Services or go online and
make a change within 60 days of the status change event,
you cannot add or drop coverage until the next Annual
Enrollment or until you have a different status change event.
Also, if the status change event is due to your dependent
losing eligibility, your dependent will lose the right to
elect COBRA coverage for medical, dental, and/or vision
benefits if you do not notify People Services of the event
within 60 days. Similarly, if the status change event is due
to your divorce, the termination of a domestic partnership,
or the termination of a legal relationship with a person
other than your spouse or domestic partner, your former
spouse/partner will lose the right to elect COBRA coverage
for medical, dental, and/or vision benefits if People Services
is not notified of the event within 60 days. See the COBRA
chapter for more information.
If your job classification changes
Transitioning from one job classification to another may
affect your eligibility for certain benefits.
If you are classified as a part‑time hourly or temporary
associate and your classification is changed to full‑time,
you will be eligible for full‑time benefits, as described in the
chart below.
If your job classification changes from full‑time associate to
part‑time or temporary associate or part‑time truck driver,
your spouse/partner will no longer be eligible for medical,
dental, vision, dependent life insurance, AD&D, critical
illness, or accident coverage. You will no longer be eligible
for company‑paid life or disability coverage. If this change
results in your spouse/partner or other dependent losing
coverage, see the COBRA chapter to learn how you and/or
your eligible dependents may be able to continue medical,
dental, and vision coverage.
NOTE: If your job classification changes to part‑time hourly
or temporary associate, see the earlier section of this
chapter titled Part-time hourly and temporary associates:
eligibility checks for medical benefits.
Transferring from one job classification to another
PART‑TIME HOURLY OR TEMPORARY ASSOCIATES TRANSFERRING TO A FULL‑TIME HOURLY POSITION (CONTINUED)
Your status at transition
Enrollment details and coverage effective dates
You have been
continuously employed
for more than 52 weeks
and were eligible for
medical coverage under
the Plan as a part‑time
hourly or temporary
associate immediately
prior to your transition
OR
You gained eligibility for
benefits by passing any
of your 60‑day eligibility
checks described earlier
in this chapter in the
section titled 60-day
measurements of hours
conducted during
the first 52 weeks of
employment
You have 60 days to enroll from the first day of the pay period in which your transition occurs.
• If you are currently enrolled in medical, dental, vision, AD&D, critical illness, or accident insurance,
you can increase your coverage type to associate + spouse/partner or associate + family as a result
of your change in job classification. If you are not currently enrolled in medical, dental, vision,
AD&D, critical illness, and/or accident insurance, you may enroll only in associate + spouse/partner
or associate + family coverage as a result of your change in job classification, until the next Annual
Enrollment or until you have a valid status change event. You may not select associate‑only or
associate + child(ren) coverage as a result of your change in job classification, as you were already
eligible for those coverage types as a part‑time hourly or temporary associate.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs,
your coverage is effective on the first day of the pay period in which your transition occurs or the
date you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in medical, dental, vision,
AD&D, critical illness, and/or accident insurance coverage after your initial enrollment period.
• You are enrolled automatically in company-paid life insurance on the first day of the pay period in
which your transition occurs.
(Continued on the next page)
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PART‑TIME HOURLY OR TEMPORARY ASSOCIATES TRANSFERRING TO A FULL‑TIME HOURLY POSITION (CONTINUED)
Your status at transition
Enrollment details and coverage effective dates
You have been
continuously employed
for more than 52 weeks
and were eligible for
medical coverage under
the Plan as a part‑time
hourly or temporary
associate immediately
prior to your transition
OR
You gained eligibility for
benefits by passing any
of your 60‑day eligibility
checks described earlier
in this chapter in the
section titled 60-day
measurements of hours
conducted during
the first 52 weeks of
employment
(Continued)
• You are eligible to enroll in optional dependent life insurance for your spouse/partner:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you enroll for the guaranteed issue amount, coverage is effective on the date you enroll.
– If you enroll for more than the guaranteed issue amount, your coverage is subject to Prudential’s
approval. You will be required to provide Proof of Good Health for your spouse/partner, who may be
required to undergo a medical exam at their own expense. If approved, your coverage is effective on
the date Prudential approves your coverage.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in optional associate and
dependent life insurance after your initial enrollment period.
• You are enrolled automatically in the short-term disability basic plan effective the later of 1) the
first day of the pay period in which your transition occurs or 2) the 12‑month anniversary of your
date of hire unless you work in the states of California, Hawaii, New Jersey, or Rhode Island, which
have legally mandated disability plans.
• You are eligible to enroll in the short-term disability enhanced plan, unless you work in the states
of California, Hawaii, New Jersey, or Rhode Island, which have legally mandated disability plans
(associates in New York can enroll in the NY short‑term disability enhanced plan) as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you have been employed for more than 52 weeks on that date, your coverage is effective on the
first day of the pay period in which your transition occurs or the date you enroll.*
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you have not been employed for more than 52 weeks on that date, your coverage is effective on the
12‑month anniversary of your date of hire.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the short‑term
disability enhanced plan after your initial enrollment period.
• You are eligible to enroll in the full-time hourly and salaried long-term disability (LTD) plan as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you have been employed for more than 52 weeks on that date, your coverage is effective on the
first day of the pay period in which your transition occurs or the date you enroll.*
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you have not been employed for more than 52 weeks on that date, your coverage is effective on the
12‑month anniversary of your date of hire.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the long‑term
disability plan after your initial enrollment period.
* Your coverage is effective either the first day of the pay period in which your transition occurs or
the date of your enrollment, depending on your choice and on the manner in which you enroll:
• If you enroll online within 60 days from the first day of the pay period in which your transition occurs,
coverage is effective the date you enroll.
• If you enroll within 60 days from the first day of the pay period in which your transition occurs by
calling People Services, you may choose for coverage to be effective either the first day of the pay
period in which your transition occurs or the date you enroll. If you choose for coverage to be effective
on the first day of the pay period in which your transition occurs, premiums are deducted from your
paycheck on an after‑tax basis retroactively to your effective date.
(Continued on the next page)
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PART‑TIME HOURLY OR TEMPORARY ASSOCIATES TRANSFERRING TO A FULL‑TIME HOURLY POSITION (CONTINUED)
Your status at transition
Coverage effective dates and details
You have been
continuously employed
for more than 52 weeks
and were not eligible for
medical coverage under
the Plan as a part‑time
hourly or temporary
associate immediately
prior to your transition
You have 60 days to enroll from the first day of the pay period in which your transition occurs.
• You are eligible to enroll in medical coverage. See The medical plan chapter for information.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in medical coverage
after your initial enrollment period.
• If you are currently enrolled in dental, vision, AD&D, critical illness, or accident insurance, you can
increase your coverage type to associate + spouse/partner or associate + family as a result of your
change in job classification. If you are not currently enrolled in dental, vision, AD&D, critical illness,
and/or accident insurance, you may enroll only in associate + spouse/partner or associate + family
coverage as a result of your change in job classification, until the next Annual Enrollment or until
you have a valid status change event. You may not select associate‑only or associate + child(ren)
coverage as a result of your change in job classification, as you were already eligible for those
coverage types as a part‑time hourly or temporary associate.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in dental, vision, AD&D,
critical illness, and/or accident insurance coverage after your initial enrollment period.*
• You are enrolled automatically in company-paid life insurance on the first day of the pay period in
which your transition occurs.
• You are eligible to enroll in optional dependent life insurance for your spouse/partner:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you enroll for the guaranteed issue amount, coverage is effective on your enrollment date.
– If you enroll for more than the guaranteed issue amount, your coverage is subject to Prudential’s
approval. You will be required to provide Proof of Good Health for your spouse/partner, who may be
required to undergo a medical exam at their own expense. If approved, your coverage is effective on
the date Prudential approves your coverage.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in optional associate and
dependent life insurance after your initial enrollment period.
• You are enrolled automatically in the full-time hourly short-term disability basic plan effective
the first day of the pay period in which your transition occurs unless you work in the states of
California, Hawaii, New Jersey, or Rhode Island, which have legally mandated disability plans.
(Continued on the next page)
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PART‑TIME HOURLY OR TEMPORARY ASSOCIATES TRANSFERRING TO A FULL‑TIME HOURLY POSITION (CONTINUED)
Your status at transition
Coverage effective dates and details
You have been
continuously employed
for more than 52 weeks
and were not eligible for
medical coverage under
the Plan as a part‑time
hourly or temporary
associate immediately
prior to your transition
(Continued)
• You are eligible to enroll in the full-time hourly short-term disability enhanced plan, unless you work
in the states of California, Hawaii, New Jersey, or Rhode Island, which have legally mandated disability
plans (associates in New York can enroll in the NY short‑term disability enhanced plan) as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the short‑term
disability enhanced plan after your initial enrollment period.
• You are eligible to enroll in the full-time hourly and salaried long-term disability (LTD) plan as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the long‑term
disability plan after your initial enrollment period.
* Your coverage is effective either the first day of the pay period in which your transition occurs or
the date of your enrollment, depending on your choice and on the manner in which you enroll:
• If you enroll online within 60 days from the first day of the pay period in which your transition occurs,
coverage is effective the date you enroll.
• If you enroll within 60 days from the first day of the pay period in which your transition occurs by
calling People Services, you may choose for coverage to be effective either the first day of the pay
period in which your transition occurs or the date you enroll. If you choose for coverage to be effective
on the first day of the pay period in which your transition occurs, premiums are deducted from your
paycheck on an after‑tax basis retroactively to your effective date.
(Continued on the next page)
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PART‑TIME HOURLY OR TEMPORARY ASSOCIATES TRANSFERRING TO A FULL‑TIME HOURLY POSITION (CONTINUED)
Your status at transition
Coverage effective dates and details
You have been
continuously employed
for more than 90 days
but less than 52 weeks
and you did not gain
eligibility for benefits
by passing any of your
60‑day eligibility checks
described earlier in
this chapter in the
section titled 60-day
measurements of hours
conducted during
the first 52 weeks of
employment
You have 60 days to enroll from the first day of the pay period in which your transition occurs.
• You are eligible to enroll in medical, dental, vision, AD&D, critical illness, and accident insurance.
See the respective chapters in this Summary Plan Description for more information.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in medical, dental, vision,
AD&D, critical illness, and/or accident insurance coverage after your initial enrollment period.
• You are enrolled automatically in company-paid life insurance on the first day of the pay period in
which your transition occurs.
• You are eligible to enroll in optional associate life insurance and optional dependent life insurance:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you enroll for the guaranteed issue amount, coverage is effective on your enrollment date.
– If you enroll for more than the guaranteed issue amount, coverage for you and your spouse/partner
is subject to Prudential’s approval. You will be required to provide Proof of Good Health for you
and your spouse/partner and may be required to undergo a medical exam at your own expense. If
approved, your coverage is effective on the date Prudential approves your coverage.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in optional associate and
dependent life insurance after your initial enrollment period.
• You are enrolled automatically in the full-time hourly short-term disability basic plan effective on
the 12‑month anniversary of your date of hire unless you work in the states of California, Hawaii,
New Jersey, or Rhode Island, which have legally mandated disability plans.
• You are eligible to enroll in the full-time hourly short-term disability enhanced plan, unless you work
in the states of California, Hawaii, New Jersey, or Rhode Island, which have legally mandated disability
plans (associates in New York can enroll in the NY short‑term disability enhanced plan) as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the later of 1) the 12‑month anniversary of your date of hire or 2) the date
you enroll.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the short‑term
disability enhanced plan after your initial enrollment period.
• You are eligible to enroll in full-time hourly and salaried long-term disability (LTD) plan coverage
as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs,
your coverage is effective on the later of 1) the 12‑month anniversary of your date of hire or
2) the date you enroll.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the long‑term
disability after your initial enrollment period.
* Your coverage is effective either the first day of the pay period in which your transition occurs or
the date of your enrollment, depending on your choice and on the manner in which you enroll:
• If you enroll online within 60 days from the first day of the pay period in which your transition occurs,
coverage is effective the date you enroll.
• If you enroll within 60 days from the first day of the pay period in which your transition occurs by
calling People Services, you may choose for coverage to be effective either the first day of the pay
period in which your transition occurs or the date you enroll. If you choose for coverage to be effective
on the first day of the pay period in which your transition occurs, premiums are deducted from your
paycheck on an after‑tax basis retroactively to your effective date.
(Continued on the next page)
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
35
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PART‑TIME HOURLY OR TEMPORARY ASSOCIATES TRANSFERRING TO A FULL‑TIME HOURLY POSITION (CONTINUED)
Your status at transition
Coverage effective dates and details
You have been
continuously employed
for more than 90 days
but less than 52 weeks
AND
You gained eligibility for
benefits by passing any
of your 60‑day eligibility
checks described earlier
in this chapter in the
section titled 60-day
measurements of hours
conducted during
the first 52 weeks of
employment
You have 60 days to enroll from the first day of the pay period in which your transition occurs.
• If you are currently enrolled in medical, dental, vision, AD&D, critical illness, or accident insurance,*
you can increase your coverage type to associate + spouse/partner or associate + family as a result
of your change in job classification. If you are not currently enrolled in medical, dental, vision,
AD&D, critical illness, and/or accident insurance, you may enroll only in associate + spouse/partner
or associate + family coverage as a result of your change in job classification, until the next Annual
Enrollment or until you have a valid status change event. You may not select associate‑only or
associate + child(ren) coverage as a result of your change in job classification, as you were already
eligible for those coverage types as a part‑time hourly or temporary associate.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs,
your coverage is effective on the first day of the pay period in which your transition occurs or the
date you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in medical, dental, vision,
AD&D, critical illness, and/or accident insurance coverage after your initial enrollment period.
• You are enrolled automatically in company-paid life insurance on the first day of the pay period in
which your transition occurs.
• You are eligible to enroll in optional dependent life insurance for your spouse/partner:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you enroll for the guaranteed issue amount, coverage is effective on your enrollment date.
– If you enroll for more than the guaranteed issue amount, your coverage is subject to Prudential’s
approval. You will be required to provide Proof of Good Health for your spouse/partner, who may be
required to undergo a medical exam at their own expense. If approved, your coverage is effective on
the date Prudential approves your coverage.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in optional dependent
life insurance after your initial enrollment period.
• You are enrolled automatically in the full-time hourly short-term disability basic plan effective
on the 12‑month anniversary of your date of hire unless you work in the states of California, Hawaii,
New Jersey, or Rhode Island, which have legally mandated disability plans.
• You are eligible to enroll in the full-time hourly short-term disability enhanced plan, unless you work
in the states of California, Hawaii, New Jersey, or Rhode Island, which have legally mandated disability
plans (associates in New York can enroll in the NY short‑term disability enhanced plan) as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs,
your coverage is effective on the later of 1) the 12‑month anniversary of your date of hire or
2) the date you enroll.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the short‑term
disability enhanced plan after your initial enrollment period.
(Continued on the next page)
36
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PART‑TIME HOURLY OR TEMPORARY ASSOCIATES TRANSFERRING TO A FULL‑TIME HOURLY POSITION (CONTINUED)
Your status at transition
Coverage effective dates and details
You have been
continuously employed
for more than 90 days
but less than 52 weeks
AND
You gained eligibility for
benefits by passing any
of your 60‑day eligibility
checks described earlier
in this chapter in the
section titled 60-day
measurements of hours
conducted during
the first 52 weeks of
employment
(Continued)
You have been
continuously employed
for less than 90 days and
you did not gain eligibility
for benefits by passing
your 60‑day eligibility
check described earlier
in this chapter in the
section titled 60-day
measurements of hours
conducted during
the first 52 weeks of
employment
• You are eligible to enroll in full-time hourly and salaried long-term disability (LTD) plan coverage
as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs,
your coverage is effective on the later of 1) the 12‑month anniversary of your date of hire or
2) the date you enroll.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the long‑term
disability after your initial enrollment period.
* Your coverage is effective either the first day of the pay period in which your transition occurs or
the date of your enrollment, depending on your choice and on the manner in which you enroll:
• If you enroll online within 60 days from the first day of the pay period in which your transition occurs,
coverage is effective the date you enroll.
• If you enroll within 60 days from the first day of the pay period in which your transition occurs by
calling People Services, you may choose for coverage to be effective either the first day of the pay
period in which your transition occurs or the date you enroll. If you choose for coverage to be effective
on the first day of the pay period in which your transition occurs, premiums are deducted from your
paycheck on an after‑tax basis retroactively to your effective date.
You have 60 days to enroll from the first day of the pay period in which your transition occurs.
• You are eligible to enroll in medical, dental, vision, AD&D, critical illness, and accident insurance.
See the respective chapters in this Summary Plan Description for more information.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs,
your coverage is effective on the first day of the calendar month during which your 89th day of
continuous full‑time employment falls or the date you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in medical, dental, vision,
AD&D, critical illness, and/or accident insurance coverage after your initial enrollment period.
• You are enrolled automatically in company-paid life insurance on the first day of the calendar
month during which your 89th day of continuous employment falls.
• You are eligible to enroll in optional associate life insurance and optional dependent life insurance:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you enroll for the guaranteed issue amount, coverage is effective on the later of 1) the first day of the
calendar month during which your 89th day of continuous employment falls or 2) the date you enroll.
– If you enroll for more than the guaranteed issue amount, coverage for you and your spouse/partner is
subject to Prudential’s approval. You will be required to provide Proof of Good Health for you and your
spouse/partner and may be required to undergo a medical exam at your own expense. If approved,
your coverage is effective on the later of 1) the first day of the calendar month during which your
89th day of continuous employment falls or 2) the date Prudential approves your coverage.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in optional associate
and dependent life insurance after your initial enrollment period.
• You are enrolled automatically in the full-time hourly short-term disability basic plan effective
on the 12‑month anniversary of your date of hire unless you work in the states of California, Hawaii,
New Jersey, or Rhode Island, which have legally mandated disability plans.
(Continued on the next page)
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
PART‑TIME HOURLY OR TEMPORARY ASSOCIATES TRANSFERRING TO A FULL‑TIME HOURLY POSITION (CONTINUED)
Your status at transition
Coverage effective dates and details
You have been
continuously employed
for less than 90 days and
you did not gain eligibility
for benefits by passing
your 60‑day eligibility
check described earlier
in this chapter in the
section titled 60-day
measurements of hours
conducted during
the first 52 weeks of
employment
(Continued)
• You are eligible to enroll in the full-time hourly short-term disability enhanced plan, unless you work
in the states of California, Hawaii, New Jersey, or Rhode Island, which have legally mandated disability
plans (associates in New York can enroll in the NY short‑term disability enhanced plan) as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the 12‑month anniversary of your date of hire.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the short‑term
disability enhanced plan after your initial enrollment period.
• You are eligible to enroll in full-time hourly and salaried long-term disability (LTD) plan coverage
as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the 12‑month anniversary of your date of hire.
37
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– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the long‑term
disability after your initial enrollment period.
* Your coverage is effective as follows:
• If you enroll online or by calling People Services within 60 days from the first day of the pay period
in which your transition occurs, and before the first day of the month during which your 89th day of
continuous full‑time employment falls, your coverage is effective the first day of the month during
which your 89th day of continuous full‑time employment falls.
• If you enroll online within 60 days from the first day of the pay period in which your transition occurs,
and after the first day of the month during which your 89th day of continuous full‑time employment
falls, your coverage is effective on the date you enroll.
• If you enroll by calling People Services within 60 days from the first day of the pay period in which
your transition occurs and after the first day of the month during which your 89th day of continuous
full‑time employment falls, you may choose for coverage to be effective on the first day of the month
during which your 89th day of continuous full‑time employment falls. In that case, premiums are
deducted from your paycheck on an after‑tax basis retroactively to your effective date.
You have 60 days to enroll from the first day of the pay period in which your transition occurs.
• If you are currently enrolled in medical, dental, vision, AD&D, critical illness, or accident insurance,
you can increase your coverage type to associate + spouse/partner or associate + family as a result
of your change in job classification. If you are not currently enrolled in medical, dental, vision,
AD&D, critical illness, and/or accident insurance, you may enroll only in associate + spouse/partner
or associate + family coverage as a result of your change in job classification, until the next Annual
Enrollment or until you have a valid status change event. You may not select associate‑only or
associate + child(ren) coverage as a result of your change in job classification, as you were already
eligible for those coverage types as a part‑time hourly or temporary associate.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in medical, dental, vision,
AD&D, critical illness, and/or accident insurance coverage after your initial enrollment period.
• You are enrolled automatically in company-paid life insurance on the first day of the calendar
month during which your 89th day of continuous full‑time employment falls.
(Continued on the next page)
You have been
continuously employed
for less than 90 days
AND
You gained eligibility
for benefits by passing
your 60‑day eligibility
checks described earlier
in this chapter in the
section titled 60-day
measurements of hours
conducted during
the first 52 weeks of
employment
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PART‑TIME HOURLY OR TEMPORARY ASSOCIATES TRANSFERRING TO A FULL‑TIME HOURLY POSITION (CONTINUED)
Your status at transition
Coverage effective dates and details
You have been
continuously employed
for less than 90 days
AND
You gained eligibility
for benefits by passing
your 60‑day eligibility
checks described earlier
in this chapter in the
section titled 60-day
measurements of hours
conducted during
the first 52 weeks of
employment
(Continued)
• You are eligible to enroll in optional associate life insurance and optional dependent life insurance:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you enroll for the guaranteed issue amount, coverage is effective on the later of 1) the first day of
the calendar month during which your 89th day of continuous full‑time employment falls or 2) the
date you enroll.
– If you enroll for more than the guaranteed issue amount, coverage for you and your spouse/partner
is subject to Prudential’s approval. You will be required to provide Proof of Good Health for you
and your spouse/partner and may be required to undergo a medical exam at your own expense. If
approved, your coverage is effective on the later of 1) the first day of the calendar month during
which your 89th day of continuous full‑time employment falls or 2) the date Prudential approves
your coverage.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in optional associate and
dependent life insurance after your initial enrollment period.
• You are enrolled automatically in the full-time hourly short-term disability basic plan effective on
the 12‑month anniversary of your date of hire unless you work in the states of California, Hawaii,
New Jersey, or Rhode Island, which have legally mandated disability plans.
• You are eligible to enroll in the full-time hourly short-term disability enhanced plan, unless you work
in the states of California, Hawaii, New Jersey, or Rhode Island, which have legally mandated disability
plans (associates in New York can enroll in the NY short‑term disability enhanced plan) as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the 12‑month anniversary of your date of hire.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the short‑term
disability enhanced plan after your initial enrollment period.
• You are eligible to enroll in full-time hourly and salaried long-term disability (LTD) plan coverage
as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the 12‑month anniversary of your date of hire.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the long‑term
disability after your initial enrollment period.
* Your coverage is effective either the first day of the pay period in which your transition occurs or
the date of your enrollment, depending on your choice and on the manner in which you enroll:
• If you enroll online within 60 days from the first day of the pay period in which your transition occurs,
coverage is effective the date you enroll.
• If you enroll within 60 days from the first day of the pay period in which your transition occurs by
calling People Services, you may choose for coverage to be effective either the first day of the pay
period in which your transition occurs or the date you enroll. If you choose for coverage to be effective
on the first day of the pay period in which your transition occurs, premiums are deducted from your
paycheck on an after‑tax basis retroactively to your effective date.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
39
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PART‑TIME HOURLY OR TEMPORARY ASSOCIATES TRANSFERRING TO MANAGEMENT (CONTINUED)
Your status at transition
Coverage effective dates and details
You have been
continuously employed
for more than 52 weeks
and were eligible for
medical coverage under
the Plan as a part‑time
hourly or temporary
associate immediately
prior to your transition
OR
You have been
continuously employed
for less than 52
weeks and you gained
eligibility for benefits
by passing any of your
60‑day eligibility checks
described earlier in
this chapter in the
section titled 60-day
measurements of hours
conducted during
the first 52 weeks of
employment
You have 60 days to enroll from the first day of the pay period in which your transition occurs.
• If you are currently enrolled in medical, dental, vision, AD&D, critical illness, or accident insurance,
you can increase your coverage type to associate + spouse/partner or associate + family as a result
of your change in job classification. If you are not currently enrolled in medical, dental, vision,
AD&D, critical illness, and/or accident insurance, you may enroll only in associate + spouse/partner
or associate + family coverage as a result of your change in job classification, until the next Annual
Enrollment or until you have a valid status change event. You may not select associate‑only or
associate + child(ren) coverage as a result of your change in job classification, as you were already
eligible for those coverage types as a part‑time hourly or temporary associate.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Management associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in medical, dental, vision,
AD&D, critical illness, and/or accident insurance coverage after your initial enrollment period.
• You are enrolled automatically in company-paid life insurance on the first day of the pay period in
which your transition occurs.
• The maximum amount of optional associate life insurance coverage you can select increases from
$200,000 to $1,000,000 and you are eligible to enroll in optional dependent life insurance for your
spouse/partner:
– If you enroll your spouse/partner within 60 days from the first day of the pay period in which your
transition occurs and you enroll for the guaranteed issue amount, coverage is effective on the date
you enroll.
– If you enroll your spouse/partner for more than the guaranteed issue amount (or increase your
coverage) coverage is subject to Prudential’s approval. You and/or your spouse/partner will each be
required to provide Proof of Good Health and may be required to undergo a medical exam at your
own expense. If approved, coverage is effective on the date Prudential approves your coverage.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Management associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in optional associate and
dependent life insurance after your initial enrollment period.
• You are enrolled automatically in the salaried short-term disability plan or truck driver short-term
disability plan, as appropriate, effective on the first day of the pay period in which your transition occurs.
• You are eligible to enroll in the full-time hourly and salaried long-term disability (LTD) plan or truck
driver LTD plan, as appropriate, as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Management associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the long‑term
disability after your initial enrollment period.
* Your coverage is effective either the first day of the pay period in which your transition occurs or the
date of your enrollment, depending on your choice and on the manner in which you enroll:
• If you enroll online within 60 days from the first day of the pay period in which your transition occurs,
coverage is effective the date you enroll.
• If you enroll within 60 days from the first day of the pay period in which your transition occurs by
calling People Services, you may choose for coverage to be effective either the first day of the pay
period in which your transition occurs or the date you enroll. If you choose for coverage to be effective
on the first day of the pay period in which your transition occurs, premiums are deducted from your
paycheck on an after‑tax basis retroactively to your effective date.
(Continued on the next page)
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PART‑TIME HOURLY OR TEMPORARY ASSOCIATES TRANSFERRING TO MANAGEMENT (CONTINUED)
Your status at transition
Coverage effective dates and details
You have been
continuously employed
for more than 52 weeks
and were not eligible for
medical coverage under
the Plan as a part‑time
hourly or temporary
associate immediately
prior to your transition
OR
You have been
continuously employed
for less than 52 weeks
and you did not gain
eligibility for benefits
by passing any of your
60‑day eligibility checks
described earlier in
this chapter in the
section titled 60-day
measurements of hours
conducted during
the first 52 weeks of
employment
You have 60 days to enroll from the first day of the pay period in which your transition occurs.
• You are eligible to enroll in medical, dental, vision, AD&D, critical illness, and accident insurance.
See the respective chapters in this Summary Plan Description for more information.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Management associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in medical, dental, vision,
AD&D, critical illness, and/or accident insurance coverage after your initial enrollment period.
• You are enrolled automatically in company-paid life insurance on the first day of the pay period in
which your transition occurs.
• The maximum amount of optional associate life insurance coverage you can select increases from
$200,000 to $1,000,000 and you are eligible to enroll in optional dependent life insurance for your
spouse/partner:
– If you enroll your spouse/partner within 60 days from the first day of the pay period in which your
transition occurs and you enroll for the guaranteed issue amount, coverage is effective on the date
you enroll.
– If you enroll your spouse/partner for more than the guaranteed issue amount (or increase your
coverage) coverage is subject to Prudential’s approval. You and/or your spouse/partner will each be
required to provide Proof of Good Health and may be required to undergo a medical exam at your
own expense. If approved, coverage is effective on the date Prudential approves your coverage.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Management associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in optional associate and
dependent life insurance after your initial enrollment period.
• You are enrolled automatically in the salaried short-term disability plan or truck driver short-term
disability plan, as appropriate, effective on the first day of the pay period in which your transition occurs.
• You are eligible to enroll in the full-time hourly and salaried long-term disability (LTD) plan or truck
driver LTD plan, as appropriate, as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Management associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the long‑term
disability plan after your initial enrollment period.
* Your coverage is effective either the first day of the pay period in which your transition occurs or
the date of your enrollment, depending on your choice and on the manner in which you enroll:
• If you enroll online within 60 days from the first day of the pay period in which your transition occurs,
coverage is effective the date you enroll.
• If you enroll within 60 days from the first day of the pay period in which your transition occurs by
calling People Services, you may choose for coverage to be effective either the first day of the pay
period in which your transition occurs or the date you enroll. If you choose for coverage to be effective
on the first day of the pay period in which your transition occurs, premiums are deducted from your
paycheck on an after‑tax basis retroactively to your effective date.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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FULL‑TIME HOURLY ASSOCIATES TRANSFERRING TO MANAGEMENT
Your status at transition
Coverage effective dates and details
You have been
continuously employed
for 90 days or more
• The maximum amount of optional associate life insurance coverage you can select increases from
$200,000 to $1,000,000.
– If you increase your coverage amount, coverage is subject to Prudential’s approval. You will be
You have been
continuously employed
for less than 90 days
required to provide Proof of Good Health and may be required to undergo a medical exam at your
own expense. If approved, coverage is effective on the date Prudential approves your coverage.
• If you enrolled in the full-time hourly short-term disability plan or the full-time hourly short-term
disability enhanced plan, your coverage will terminated effective the first day of the pay period in
which your transition occurs.
• You are enrolled automatically in the salaried short-term disability plan or the truck driver short-term
disability plan, as appropriate, effective on the first day of the pay period in which your transition occurs.
• Your long-term disability coverage will change as follows:
– If you elected the full-time hourly and salaried long-term disability (LTD) plan during your initial
enrollment period (when you were a full‑time hourly associate) and it is not effective at the time of your
transition, your coverage is effective the first day of the pay period in which your transition occurs.
– If you did not elect the full-time hourly and salaried long-term disability (LTD) plan coverage during
your initial enrollment period (when you were a full‑time hourly associate) see the Management
associates chart in the Enrollment and effective dates by job classification section earlier in this
chapter for rules that apply if you enroll in long‑term disability after your initial enrollment period.
You have 60 days to enroll from the first day of the pay period in which your transition occurs.
• You are eligible to enroll in medical, dental, vision, AD&D, critical illness, and accident insurance.
See the respective chapters in this Summary Plan Description for more information.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
• You are enrolled automatically in company-paid life insurance on the first day of the pay period in
which your transition occurs.
• You are eligible to enroll in optional associate life insurance and optional dependent life insurance:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you enroll for the guaranteed issue amount, coverage is effective on your enrollment date.
– If you enroll for more than the guaranteed issue amount, coverage for you and your spouse/partner
is subject to Prudential’s approval. You will be required to provide Proof of Good Health for you
and your spouse/partner and may be required to undergo a medical exam at your own expense. If
approved, your coverage is effective on the date Prudential approves your coverage.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Management associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in optional associate and
dependent life insurance after your initial enrollment period.
• You are enrolled automatically in the salaried short-term disability plan or truck driver short-term
disability plan, as appropriate, effective on the first day of the pay period in which your transition occurs.
• You are eligible to enroll in the full-time hourly and salaried long-term disability (LTD) plan or truck
driver LTD plan, as appropriate, as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
– If you do not enroll within 60 days from the first day of the pay period in which your transition occurs,
see the Management associates chart in the Enrollment and effective dates by job classification
section earlier in this chapter for rules that apply if you enroll in the long‑term disability after your
initial enrollment period.
* Your coverage is effective either the first day of the pay period in which your transition occurs or the
date of your enrollment, depending on your choice and on the manner in which you enroll:
• If you enroll online within 60 days from the first day of the pay period in which your transition
occurs, coverage is effective the date you enroll.
• If you enroll within 60 days from the first day of the pay period in which your transition occurs by
calling People Services, you may choose for coverage to be effective either the first day of the
pay period in which your transition occurs or the date you enroll. If you choose for coverage to be
effective on the first day of the pay period in which your transition occurs, premiums are deducted
from your paycheck on an after‑tax basis retroactively to your effective date.
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FULL‑TIME HOURLY VISION CENTER MANAGERS TRANSFERRING TO MANAGEMENT
Coverage effective dates and details
• Your eligibility for coverage under the full-time hourly short-term disability basic plan and the
short-term disability enhanced plan will be terminated effective the day prior to the first day of
the pay period in which your transition occurs.
• You are enrolled automatically in the salaried short-term disability plan the first day of the pay
period in which your transition occurs.
MANAGEMENT ASSOCIATES TRANSFERRING TO FULL‑TIME HOURLY (CONTINUED)
Your status at transition
Coverage effective dates and details
Within 60 days of your
date of hire and before
you have enrolled
for benefits
You have 60 days to enroll from the first day of the pay period in which your transition occurs.
• You are eligible to enroll in medical, dental, vision, AD&D, critical illness, and accident insurance.
See the respective chapters in this Summary Plan Description for more information.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which your transition occurs or the date
you enroll.*
• You are eligible to enroll in optional associate life insurance and optional dependent life insurance:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs and
you enroll for the guaranteed issue amount, coverage is effective on the date you enroll.
– If you enroll for more than the guaranteed issue amount, coverage for you and your spouse/partner
is subject to Prudential’s approval. You will be required to provide Proof of Good Health for you
and your spouse/partner and may be required to undergo a medical exam at your own expense.
If approved, your coverage is effective on the date Prudential approves your coverage.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in optional associate and
dependent life insurance after your initial enrollment period.
• You are no longer enrolled in the salaried short-term disability plan or the truck driver short-term
disability plan, as applicable, effective the day prior to the first day of the pay period in which your
transition occurs.
• You are enrolled automatically in full-time hourly short-term disability enhanced plan unless you
work in the states of California, Hawaii, New Jersey, or Rhode Island, which have legally mandated
disability plans. (Associates in New York are enrolled automatically in the NY short‑term disability
enhanced plan.) See the Full-time hourly short-term disability chapter for more information.
You can change this election within 60 days from the first day of the pay period in which your
transition occurs.
– If you do not change the election within 60 days from the first day of the pay period in which
your transition occurs, your coverage is effective on the first day of the pay period in which your
transition occurs.
– If you do change your election (i.e., you cancel enrollment in the full-time hourly short-term
disability enhanced coverage) within 60 days from the first day of the pay period in which your
transition occurs, see the Full-time hourly associates chart in the Enrollment and effective dates
by job classification section earlier in this chapter for rules that apply if you enroll in the short‑term
disability enhanced plan after your initial enrollment period. You are enrolled automatically in the
full-time hourly short-term disability basic plan effective on the first day of the pay period in which
your transition occurs unless you work in the states of California, Hawaii, New Jersey, or Rhode
Island, which have legally mandated disability plans.
(Continued on the next page)
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
MANAGEMENT ASSOCIATES TRANSFERRING TO FULL‑TIME HOURLY (CONTINUED)
Your status at transition
Coverage effective dates and details
Within 60 days of your
date of hire and before
you have enrolled
for benefits
(Continued)
• You are eligible to enroll in full-time hourly and salaried long-term disability (LTD) plan coverage
as follows:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs,
your coverage is effective on the first day of the pay period in which your transition occurs.
– If you do not enroll within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the long‑term
disability after your initial enrollment period.
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Within 60 days of your
date of hire and after
you have enrolled
for benefits
* Your coverage is effective either the first day of the pay period in which your transition occurs or the
date you enroll, depending on your choice and on the manner in which you enroll:
• If you enroll online within 60 days from the first day of the pay period in which your transition occurs,
coverage is effective the date you enroll.
• If you enroll within 60 days from the first day of the pay period in which your transition occurs by
calling People Services, you may choose for coverage to be effective either the first day of the pay
period in which your transition occurs or the date you enroll. If you choose for coverage to be effective
on the first day of the pay period in which your transition occurs, premiums are deducted from your
paycheck on an after‑tax basis retroactively to your effective date.
You have 60 days to enroll from the date your transition in status occurs.
• Optional associate life insurance coverage amounts over $200,000 are reduced to $200,000.
• Your enrollment in the salaried short-term disability plan or the truck driver short-term disability
plan, as appropriate, is canceled effective the day prior to the first day of the pay period in which
your transition occurs.
• You are enrolled automatically in the full-time hourly short-term disability enhanced plan unless you
work in the states of California, Hawaii, New Jersey, or Rhode Island, which have legally mandated
disability plans. (Associates in New York are enrolled automatically in the NY short‑term disability
enhanced plan.) See the Full-time hourly short-term disability chapter for more information. You can
change this election within 60 days from the first day of the pay period in which your transition occurs.
– If you do not change the election within 60 days from the first day of the pay period in which
your transition occurs, your coverage is effective on the first day of the pay period in which your
transition occurs.
– If you do change your election (i.e., you cancel enrollment in the short-term disability enhanced
coverage) within 60 days from the first day of the pay period in which your transition occurs, see the
Full-time hourly associates chart in the Enrollment and effective dates by job classification section
earlier in this chapter for rules that apply if you enroll in the short‑term disability enhanced plan
after your initial enrollment period. You are enrolled automatically in the full-time hourly short-
term disability basic plan effective on the first day of the pay period in which your transition
occurs unless you work in the states of California, Hawaii, New Jersey, or Rhode Island, which
have legally mandated disability plans.
(Continued on the next page)
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MANAGEMENT ASSOCIATES TRANSFERRING TO FULL‑TIME HOURLY (CONTINUED)
Your status at transition
Coverage effective dates and details
More than 60 days after
your date of hire
If you are currently enrolled for benefits, you have 60 days to make a new enrollment from the date
your transition occurs.
• Optional associate life insurance coverage amounts over $200,000 are reduced to $200,000.
• Your enrollment in the salaried short-term disability plan or the truck driver short-term disability
plan, as appropriate, is canceled effective the day prior to the first day of the pay period in which
your transition occurs.
• You are enrolled automatically in the full-time hourly short-term disability enhanced plan unless
you work in the states of California, Hawaii, New Jersey, or Rhode Island, which have legally
mandated disability plans. (Associates in New York are enrolled automatically in the NY short‑term
disability enhanced plan.) See the Full-time hourly short-term disability chapter for more
information. You can change this election within 60 days from the first day of the pay period in
which your transition occurs.
– If you do not change the election within 60 days from the first day of the pay period in which
your transition occurs, your coverage is effective on the first day of the pay period in which your
transition occurs.
– If you do change your election (i.e., you cancel enrollment in full-time hourly short-term disability
enhanced coverage) within 60 days from the first day of the pay period in which your transition
occurs, see the Full-time hourly associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in the short‑term
disability enhanced plan after your initial enrollment period. You are enrolled automatically in the
full-time hourly short-term disability basic plan effective on the first day of the pay period in
which your transition occurs unless you work in the states of California, Hawaii, New Jersey, or
Rhode Island, which have legally mandated disability plans.
FULL‑TIME HOURLY ASSOCIATES TRANSFERRING TO PART‑TIME HOURLY OR TEMPORARY (CONTINUED)
Your status at transition
Coverage effective dates and details
You have met your
eligibility waiting period
and were eligible for
coverage under the Plan
immediately prior to
your transition
• If you are enrolled in medical, dental, vision, AD&D, critical illness, or accident insurance coverage,
your coverage type is automatically adjusted to associate‑only or associate + child(ren) (depending
on whether you have covered dependents), effective the first day of the pay period after your
transition occurs. Associate + spouse/partner and associate + family coverage are not available to
part‑time hourly or temporary associates.
• Your enrollment in company-paid life insurance is canceled effective the day prior to the first day
of the pay period in which your transition occurs. You may be able to convert your company‑paid
life insurance to individual policies.
• If you enrolled your spouse/partner in optional dependent life insurance, coverage for your
spouse/partner is canceled effective the day prior to the first day of the pay period in which your
transition occurs. You may be able to convert your spouse/partner life insurance to an individual policy.
• Your enrollment in the full-time hourly short-term disability basic plan and short-term disability
enhanced plan (if you enrolled) is canceled effective the day prior to the first day of the pay period
in which your transition occurs.
• If you elected the full-time hourly long-term disability plan, your enrollment is canceled effective
the day prior to the first day of the pay period in which your transition occurs.
(Continued on the next page)
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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FULL‑TIME HOURLY ASSOCIATES TRANSFERRING TO PART‑TIME HOURLY OR TEMPORARY (CONTINUED)
Your status at transition
Coverage effective dates and details
You have NOT met your
eligibility waiting period
You have 60 days to enroll from the first day of the pay period in which your transition occurs.
• You are eligible to enroll in medical, dental, vision, AD&D, critical illness, and accident coverage for
you and your children. You are eligible to enroll in associate‑only or associate + child(ren) coverage
types. See the respective chapters in this Summary Plan Description for more information.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs but
before the first day of the calendar month during which your 89th day of continuous employment
falls, your coverage is effective on the first day of the calendar month during which your 89th day
of continuous employment falls.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs but
after the first day of the calendar month during which your 89th day of continuous employment
falls, your coverage is effective on the first day of the calendar month during which your 89th day
of continuous full‑time employment falls or the date you enroll.*
• You are eligible to enroll in optional associate life insurance and optional dependent life insurance
for your children:
– If you enroll within 60 days from the first day of the pay period in which your transition occurs but
before the first day of the calendar month during which your 89th day of continuous employment
falls and you enroll for the guaranteed amount, coverage is effective on the first day of the calendar
month during which your 89th day of continuous employment falls.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs but after
the first day of the calendar month during which your 89th day of continuous full‑time employment
falls and you enroll for the guaranteed amount, your coverage is effective the date you enroll.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs
but before the first day of the calendar month during which your 89th day of continuous full‑time
employment falls and you enroll for more than the guaranteed amount, your coverage is subject to
Prudential’s approval. You will be required to provide Proof of Good Health and may be required to
undergo a medical exam at your own expense. If approved, your coverage is effective on the later of
the first day of the calendar month during which your 89th day of continuous full‑time employment
falls or date Prudential approves your coverage.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs
but after the first day of the calendar month during which your 89th day of continuous full‑time
employment falls and you enroll for more than the guaranteed amount, your coverage is subject to
Prudential’s approval. You will be required to provide Proof of Good Health and may be required to
undergo a medical exam at your own expense. If approved, your coverage is effective on the date
Prudential approves your coverage.
– If you do not enroll within 60 days from the first day of the pay period in which your transition occurs,
see the Part-time hourly and temporary associates chart in the Enrollment and effective dates by job
classification section earlier in this chapter for rules that apply if you enroll in optional associate and
dependent life insurance after your initial enrollment period.
• If you enrolled your spouse/partner in optional dependent life insurance, coverage for your
spouse/partner is canceled effective the day prior to the first day of the pay period in which your
transition occurs.
• Your enrollment in the in the full-time hourly short-term disability basic plan and short-term
disability enhanced plan (if you enrolled) is canceled effective the day prior to the first day of the
pay period in which your transition occurs.
(Continued on the next page)
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FULL‑TIME HOURLY ASSOCIATES TRANSFERRING TO PART‑TIME HOURLY OR TEMPORARY (CONTINUED)
Your status at transition
Coverage effective dates and details
You have NOT met your
eligibility waiting period
(Continued)
• If you elected the full-time hourly and salaried long-term disability plan, your enrollment is
canceled effective the day prior to the first day of the pay period in which your transition occurs.
* Your coverage is effective as follows:
• If you enroll online or by calling People Services within 60 days from the first day of the pay period
in which your transition occurs, and before the first day of the month during which your 89th day of
continuous full‑time employment falls, your coverage is effective the first day of the month during
which your 89th day of continuous employment falls.
• If you enroll online within 60 days from the first day of the pay period in which your transition occurs,
and after the first day of the month during which your 89th day of continuous employment falls, your
coverage is effective on the date you enroll.
• If you enroll by calling People Services within 60 days from the first day of the pay period in which
your transition occurs and after the first day of the month during which your 89th day of continuous
full‑time employment falls, you may choose for coverage to be effective on the first day of the month
during which your 89th day of continuous employment falls. In that case, premiums are deducted
from your paycheck on an after‑tax basis retroactively to your effective date.
MANAGEMENT ASSOCIATES TRANSFERRING TO PART‑TIME HOURLY OR TEMPORARY (CONTINUED)
Your status at transition
Coverage effective dates and details
You are within 60 days
of your date of hire
but have not enrolled
for benefits
You have 60 days to enroll from the date your transition in status occurs.
• You are eligible to enroll in medical, dental, vision, AD&D, critical illness, and accident coverage
for you and your children. You are eligible to enroll in associate‑only or associate + child(ren)
coverage types. See the respective chapters in this Summary Plan Description for more
information.
– If you enroll within 60 days from the first day of the pay period in which your transition occurs, your
coverage is effective on the first day of the pay period in which you enroll or the date you enroll.*
• Your enrollment in company-paid life insurance is canceled effective the day prior to the first day
of the pay period in which your transition occurs. You may be able to convert your company‑paid
life insurance to an individual policy.
• Your enrollment in the salaried short-term disability plan or the truck driver short-term disability
plan, as appropriate, is canceled effective the day prior to the first day of the pay period in which
your transition occurs.
* Your coverage is effective either the first day of the pay period in which your transition occurs or the
date you enroll, depending on your choice and on the manner in which you enroll:
• If you enroll online within 60 days from the first day of the pay period in which your transition occurs,
coverage is effective the date you enroll.
• If you enroll within 60 days from the first day of the pay period in which your transition occurs by
calling People Services, you may choose for coverage to be effective either the first day of the pay
period in which your transition occurs or the date you enroll. If you choose for coverage to be effective
on the first day of the pay period in which your transition occurs, premiums are deducted from your
paycheck on an after‑tax basis retroactively to your effective date.
(Continued on the next page)
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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Your status at transition
Coverage effective dates and details
You are within 60 days
of your date of hire
and you have enrolled for
benefits
More than 60 days have
passed since your date
of hire
You have 60 days to enroll from the date your transition in status occurs.
• If you are enrolled in medical, dental, vision, AD&D, critical illness, or accident insurance coverage,
your coverage type is automatically adjusted to associate‑only or associate + child(ren) (depending
on whether you have covered dependents), effective the first day of the pay period after your
transition occurs. Associate + spouse/partner and associate + family coverage are not available to
part‑time hourly or temporary associates.
• Your enrollment in company-paid life insurance is canceled effective the day prior to the first day
of the pay period in which your transition occurs. You may be able to convert your company‑paid
life insurance to an individual policy.
• Optional associate life insurance coverage amounts over $200,000 are reduced to $200,000.
• If you enrolled your spouse/partner in optional dependent life insurance, coverage for your
spouse/partner is canceled effective the day prior to the first day of the pay period in which your
transition occurs. You may be able to convert your spouse/partner life insurance to an individual policy.
• Your enrollment in the salaried short-term disability plan or the truck driver short-term disability
plan, as appropriate, is canceled effective the day prior to the first day of the pay period in which
your transition occurs.
• If you elected the full-time hourly and salaried long-term disability (LTD) plan or the truck driver
LTD plan, as appropriate, your enrollment is canceled effective the day prior to the first day of the
pay period in which your transition occurs.
You have 60 days to enroll from the date your transition in status occurs.
• If you are enrolled in medical, dental, vision, AD&D, critical illness, or accident insurance coverage,
your coverage type is automatically adjusted to associate‑only or associate + child(ren) (depending on
whether you have covered dependents), effective the first day of the pay period after your transition
occurs. Associate + spouse/partner and associate + family coverage are not available to part‑time
hourly or temporary associates.
• Your enrollment in company-paid life insurance is canceled effective the day prior to the first day
of the pay period in which your transition occurs. You may be able to convert your company‑paid
life insurance to individual policies.
• Optional associate life insurance coverage amounts over $200,000 are reduced to $200,000.
• If you enrolled your spouse/partner in optional dependent life insurance, coverage for your
spouse/partner is canceled effective the day prior to the first day of the pay period in which your
transition occurs. You may be able to convert your spouse/partner life insurance to individual policies.
• Your enrollment in the salaried short-term disability plan or the truck driver short-term disability
plan, as appropriate, is canceled effective the day prior to the first day of the pay period in which
your transition occurs.
• If you elected the full-time hourly and salaried long-term disability (LTD) plan or the truck driver
LTD plan, as appropriate, your enrollment is canceled effective the day prior to the first day of the
pay period in which your transition occurs.
You have 60 days from the date of your transition to a part‑time hourly, temporary, or part‑time truck driver position to
elect any other medical coverage option available to you and/or your dependents under the Plan. You may not drop medical,
dental, AD&D, critical illness, accident, or vision coverage for yourself and/or your dependent children during the Plan year.
If you do not elect to change your coverage option within the 60‑day enrollment period, you will continue to be covered
by the same full‑time medical option, but excluding spouse/partner coverage. You may change elections during any future
Annual Enrollment or as the result of a status change event.
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Qualified Medical Child Support
Orders (QMCSO)
A QMCSO is a court or administrative agency order
requiring an associate or other parent or guardian to
provide health care coverage for eligible dependents after
a divorce or child custody proceeding. Federal law requires
the Plan to provide medical, dental and/or vision benefits
to any eligible dependent of a Plan participant required by
a court order meeting the qualifications of a QMCSO.
You can obtain the written procedures for determining
whether an order meets the federal requirements, free
of charge, by contacting Medical Support Services at
877-930-5607.
Once the Plan determines an order to be a QMCSO,
coverage begins the first day of the pay period in which the
Plan receives the order, unless another date is specified in
the order. If you are eligible for the medical, dental, and/or
vision plan and did not elect coverage before the order was
received, you will be enrolled in the 2022 default Premier
Plan with associate + child(ren) coverage at the tobacco
rate, unless the QMCSO specifies otherwise. If you are in
the state of Hawaii, the default plan is Health Plan Hawaii
(HMSA). If you are in a location where the PPO Plan is
offered, the default plan is the Saver Plan.
If you were enrolled in coverage before the order was
received, your child will be added under your existing
coverage, with the following exceptions:
• If you are enrolled in an HMO plan or one of the local
plans, your coverage will change to the Premier Plan,
under which the child would have coverage regardless of
where he or she lives.
• If you are enrolled in the PPO Plan, your coverage will
change to the Saver Plan, under which the child would
have coverage regardless of where he or she lives.
• If you are in the state of Hawaii, your coverage will change
to HMSA.
You have 60 days to call Medical Support Services at
877-930-5607 to select an alternative medical plan.
When the Plan receives a QMCSO, it will apply the
following rules:
• If the Plan receives a QMCSO when you are eligible
but prior to you satisfying your initial waiting period for
medical coverage, the order will be put into effect when
your initial waiting period is satisfied.
• If you are ineligible for coverage when the Plan receives
a QMCSO, the order will be rejected.
• If you are ineligible for coverage when the plan receives
a QMCSO but subsequently become eligible, the Plan
requires a new QMCSO before coverage for your
dependent can take effect.
• If you are eligible for coverage when the Plan receives
a QMCSO and you lose eligibility, and then subsequently
regain eligibility, the Plan requires a new QMCSO before
coverage for your dependent can take effect.
• If you are eligible for coverage when the Plan receives
a QMCSO, then become ineligible and then subsequently
regain eligibility, the Plan requires a new QMCSO before
coverage for your dependent can take effect.
• If you are eligible for coverage and have a QMCSO in
effect, then terminate, then are rehired and become
eligible again, the Plan requires a new QMCSO before
coverage can take effect.
When the third‑party administrator enforces coverage
for a court‑ordered dependent, information regarding
the dependent is shared only with the legal custodian.
If you have questions, contact Medical Support Services
at 877-930-5607.
DROPPING OR CHANGING
QMCSO COVERAGE
You may drop the court‑ordered QMCSO coverage if the
following applies:
• The QMCSO is terminated by a court or administrative
agency order — you must request your change within
60 days.
• The QMCSO is rescinded by a court or administrative
agency order.
• A child who is the subject of the court order reaches the
age identified in the state issuing the court order for
termination of coverage. Contact your state child support
enforcement agency for details.
If the QMCSO is terminated or rescinded by court or
administrative agency order, the court‑ordered coverage
will end on the date specified in the order or the first day
of the pay period in which the Plan receives the order. If
the order to rescind coverage is received, coverage will
be retroactively withdrawn and you will be returned to the
coverage status you had before the QMCSO was enforced,
to the extent permitted by law.
When a QMCSO terminates, you may drop medical, dental,
and/or vision coverage for the children named in the
QMCSO. You may not drop your own coverage or coverage
for any dependent voluntarily added after the QMCSO
became effective unless there is a change in status for you
or your child, or during Annual Enrollment. However, you
may change your medical plan option by calling People
Services, as long as you request the change within 60 days
of the termination order. For dental coverage, you may not
drop associate‑level coverage at Annual Enrollment or due
to a status change event unless you have been covered for
two full calendar years.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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When your Plan coverage ends
Coverage under the Associates’ Health and Welfare Plan
for you and your dependents ends on the earliest of
the following:
• At termination of your employment
• On the last day of coverage for which premiums were paid,
if you fail to pay your premiums within 30 days of the date
your premium is due
• On the date of your (the associate’s) death, for you and
your dependents
• On the date of death for a deceased dependent
• On the date you, a dependent spouse/partner, or child
loses eligibility
• When the benefit is no longer offered by Walmart
• Upon misrepresentation or the fraudulent submission of
a claim for benefits or eligibility, or
• Upon an act of fraud or a misstatement of a material fact.
If you voluntarily drop coverage after a status change event
or at Annual Enrollment, coverage ends as follows:
• After a status change event: coverage ends on the
effective date of the event. See Status change events in
this chapter for information.
• At Annual Enrollment: coverage ends on December 31
of the current year.
Premium deductions are withheld from your final
paycheck since those deductions pay for coverage
during that pay period.
Eligibility and
benefits for
associates in Hawaii
Eligibility waiting periods for medical coverage
Medical coverage options for Hawaii associates
Paying premiums during a leave of absence for Hawaii associates
Enrollment and effective dates for Hawaii associates
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2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Eligibility and benefits for associates in Hawaii
Because you work in Hawaii, there are some special rules about medical and short‑term disability
benefits. Those differences are described in this chapter. The rest of the information in this 2022
Associate Benefits Book applies to you.
RESOURCES
Find What You Need
Online
Health Plan Hawaii (HMSA)
Go to hmsa.com
Other Resources
808-948-6372
Kaiser Foundation Health Plan
Go to kaiserpermanente.org
800-966-5955
Enroll in Walmart benefits
Go to One.Walmart.com
Call People Services at 800-421-1362
Report a claim under the legally mandated
state disability insurance program
Go to One.Walmart.com or directly to
MyLincolnPortal.com
Call Lincoln at 800-492-5678
Notify People Services within 60 days of a
status change event
Go to One.Walmart.com
Call People Services at 800-421-1362
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What you need to know as a Hawaii associate
• Associates in Hawaii have two medical coverage options: Health Plan Hawaii (HMSA) and the Kaiser Foundation Health Plan.
For information about these medical options, go to One.Walmart.com, or refer to the contact information for each option in
the chart above.
• Because Hawaii has a legally mandated disability plan, the company short‑term disability plan for hourly associates is not
an option for associates in Hawaii.
• Initial eligibility periods for coverage vary for Hawaii associates based on their employment status, as described in this chapter.
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Eligibility waiting periods for
medical coverage
MANAGEMENT ASSOCIATES
If you are a management associate in Hawaii, the eligibility
terms described in the Eligibility and enrollment
chapter apply to you; management associates and
management trainees in Hawaii are eligible for medical
coverage on their date of hire. For details on eligibility
and enrollment in all of the benefits available under the
Associates’ Health and Welfare Plan, refer to the chart for
management associates in the Enrollment and effective
dates by job classification section of the Eligibility and
enrollment chapter.
FULL-TIME HOURLY, PART-TIME HOURLY
AND TEMPORARY ASSOCIATES
If you are a full‑time hourly associate (including full‑time
hourly pharmacists and field supervisor positions in
stores and clubs) or a part‑time hourly and temporary
associate in Hawaii, your eligibility for medical coverage is
subject to special rules applicable to Hawaii associates. For
benefits other than medical, eligibility terms are described
in the Eligibility and enrollment chapter. Eligibility for
other benefits is also described in charts under Enrollment
and effective dates for Hawaii associates later in this
chapter. For details refer to the appropriate chart.
Medical coverage options for
Hawaii associates
Associates in Hawaii have two coverage options:
• Health Plan Hawaii (HMSA), and
• Kaiser Foundation Health Plan.
For details about these medical options, visit the websites
listed in the Resources chart at the beginning of this chapter.
Paying premiums during a leave of
absence for Hawaii associates
Because the associate portion of your medical premium
is wage‑based, no premium is due from you if you are not
receiving wages during an approved leave of absence. The
only premium due for medical coverage while you are on an
approved leave of absence with no wages is the dependent
portion of your premium. All other benefit options require
payment during an approved leave of absence as described
in the Eligibility and enrollment chapter.
Under Hawaii law, Walmart must contribute at least 50% of
the premium for your (associate only) medical coverage,
but not for dependent coverage. Associates are required to
pay the rest of the biweekly cost of the premium, but only
up to 1.5% of their wages or 50% of the biweekly cost of the
premium, whichever is less. For example: if your biweekly
wages are $1,000 and you qualify for tobacco‑free rates, you
are not required to pay more than $15 biweekly for coverage
(assuming that the entire premium is at least $30 biweekly).
Enrollment and effective dates for Hawaii associates
FULL‑TIME HOURLY ASSOCIATES (CONTINUED)
Includes full‑time hourly pharmacists and field supervisor positions in stores and clubs
NOTE: Don’t confuse the initial enrollment period with the coverage effective date. You must enroll in coverage prior to the coverage effective
date for most benefits.
Plan
Medical
Dental (enrollment is for two full
calendar years)
Vision
Critical illness insurance
Accident insurance
AD&D
Enrollment Periods and Effective Dates
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day prior to
your effective date.
When coverage is effective:
Your coverage is effective the earlier of:
• The first day of the pay period following a period of
working at least 20 hours per week for four consecutive
weeks, or
• The first day of the calendar month during which your
89th day of continuous full‑time employment falls.
Initial enrollment period:
You must enroll in coverage between the date of your
first paycheck and the day prior to your coverage
effective date.
If you elect coverage, your
election must remain in effect
until the end of the calendar
year containing the coverage
effective date and may not
be changed until Annual
Enrollment for the next
calendar year or you experience
a status change event, as
described in the Status change
events section of the Eligibility
and enrollment chapter.
When coverage is effective:
Your coverage is effective the first day of the calendar month during which your 89th day of
continuous full‑time employment falls.
(Continued on the next page)
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
FULL‑TIME HOURLY ASSOCIATES (CONTINUED)
Includes full‑time hourly pharmacists and field supervisor positions in stores and clubs
NOTE: Don’t confuse the initial enrollment period with the coverage effective date. You must enroll in coverage prior to the coverage effective
date for most benefits.
Plan
Enrollment Periods and Effective Dates
Company‑paid life insurance
You are automatically enrolled on the first day of the calendar month during which your
89th day of continuous full‑time employment falls.
Resources for Living
You are automatically enrolled on your date of hire.
Business travel accident insurance
Short‑term disability
(state‑mandated plan)
Contact Lincoln for information on eligibility and effective date; see the Resources chart
at the beginning of this chapter.
Optional associate life insurance
Optional dependent life insurance
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day prior to
your coverage effective date.
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When coverage is effective:
If you enroll during your initial enrollment period:
• The guaranteed issue amount is effective on the later of 1) the date you enroll, or
2) the first day of the calendar month during which your 89th day of continuous full‑time
employment falls.
• When you enroll for more than the guaranteed issue amount, your coverage is subject to
Prudential’s approval. You will be required to provide Proof of Good Health for yourself
and/or your spouse/partner and may be required to undergo a medical exam at your own
expense. If approved, your coverage is effective on the later of 1) the date Prudential
approves your coverage, or 2)the first day of the calendar month during which your
89th day of continuous full‑time employment falls.
If you enroll after your initial enrollment period: You may enroll in, increase, or drop
coverage at any time during the year, but your coverage (including an increase) is subject to
Prudential’s approval. You will be required to provide Proof of Good Health for yourself and/or
your spouse/partner and may be required to undergo a medical exam at your own expense.
If approved, your coverage is effective on the date Prudential approves your coverage.
Long‑term disability (LTD) plan
LTD enhanced plan
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day prior
to first day of the calendar month during which your 89th day of continuous full‑time
employment falls.
When coverage is effective:
• If you enroll in coverage during your initial enrollment period: Coverage is effective after
a 12‑month waiting period that begins on your date of hire; i.e., your one‑year anniversary.
• If you enroll in coverage after your initial enrollment period: Your coverage is subject
to Lincoln’s approval. You will be required to submit Proof of Good Health and may be
required to undergo a medical exam at your own expense.
– If you enroll in coverage following a status change event and are approved, your
coverage is effective on the first day of the pay period following the date Lincoln
approves your coverage.
– If you enroll in coverage during Annual Enrollment and are approved, your coverage will
be effective January 1 of the following year.
– If you are not approved, you may be eligible to enroll during the next Annual Enrollment
or after a status change event but will be subject to the same Proof of Good Health
requirements.
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If you elect coverage, your
election must remain in effect
until the end of the calendar
year containing the coverage
effective date and may not be
changed until Annual Enrollment
for the next calendar year or you
experience a status change event,
as described in the Status change
events section of the Eligibility
and enrollment chapter.
PART‑TIME HOURLY AND TEMPORARY ASSOCIATES
NOTE: Don’t confuse the initial enrollment period with the coverage effective date. You must enroll in coverage prior to the coverage effective
date for most benefits.
Plan
Medical*
Enrollment Periods and Effective Dates
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day prior
to your effective date.
* Part‑time hourly and temporary
associates in Hawaii are not subject
to the requirements described under
Part-time hourly and temporary
associates: eligibility checks for
medical benefits in the Eligibility and
enrollment chapter.
When coverage is effective:
Your coverage is effective the earlier of:
• The first day of the pay period following a period
of working at least 20 hours per week for four
consecutive weeks, or
• The first day of the calendar month during which
your 89th day of continuous employment falls.
Dental (enrollment is for two full
calendar years)
Vision
Critical illness insurance
Accident insurance
AD&D
Initial enrollment period:
You must enroll in coverage between the date of your
first paycheck and the day prior to your coverage
effective date.
When coverage is effective:
Your coverage is effective the first day of the calendar month during which your
89th day of continuous employment falls.
Resources for Living
You are automatically enrolled on your date of hire.
Business travel accident insurance
Short‑term disability
(state‑mandated plan)
Contact Lincoln for information on eligibility and effective date; see the Resources
chart at the beginning of this chapter.
Optional associate life insurance
Optional dependent life insurance
Initial enrollment period:
You must enroll in coverage between the date of your first paycheck and the day prior
to your coverage effective date.
When coverage is effective:
If you enroll during your initial enrollment period:
• The guaranteed issue amount is effective on the later of 1) the date you enroll, or
2) the first day of the calendar month during which your 89th day of continuous
employment falls.
• When you enroll for more than the guaranteed issue amount, your coverage is subject
to Prudential’s approval. You will be required to provide Proof of Good Health and
may be required to undergo a medical exam at your own expense. If approved, your
coverage is effective on the later of 1) the date Prudential approves your coverage,
or 2) the first day of the calendar month during which your 89th day of continuous
employment falls.
If you enroll after your initial enrollment period: You may enroll in, increase, or drop
coverage at any time during the year, but your coverage (including an increase) is
subject to Prudential’s approval. You will be required to provide Proof of Good Health
and may be required to undergo a medical exam at your own expense. If approved, your
coverage is effective on the date Prudential approves your coverage.
NOTE: Part‑time hourly and temporary associates may only cover their eligible dependent children and may not cover
their spouses/partners. Disability coverage and company‑paid life insurance are not available to part‑time hourly and
temporary associates.
Management associates: Refer to the chart for management associates in the Enrollment and effective dates by job
classification section of the Eligibility and enrollment chapter.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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The medical plan
The Associates’ Medical Plan (AMP)
Enrollment
Role of third‑party administrator
AMP options available to you
Evaluating your options
Provider networks
Centers of Excellence
Walmart Clinics
Helping you manage your health
Preventive care program
Behavioral health: Mental health and substance use disorder
What is covered by the AMP
Prenotification
Preauthorization
When limited benefits apply to the AMP
What is not covered by the AMP
Filing a medical claim
If you have coverage under more than one medical plan
Break in coverage
When coverage ends
If you leave the company and are rehired
If you drop coverage and reenroll
Other information about the medical plan
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The medical plan
RESOURCES
Find What You Need
Online
Aetna (Premier, Contribution,
Saver, and Banner Local Plan)
Go to One.Walmart.com or
aetna.com
By Phone:
Health Care
Advisor
855-548-2387
Other Resources
Aetna
151 Farmington Avenue
Hartford, Connecticut 06156
BlueAdvantage Administrators
of Arkansas (Premier,
Contribution, and Saver Plan)
Go to One.Walmart.com or
blueadvantagearkansas.com
866-823-3790
UMR (Premier, Contribution,
and Saver Plan)
Go to One.Walmart.com or
UMR.com
855-870-9177
BlueAdvantage Administrators of Arkansas
P.O. Box 1460
Little Rock, Arkansas 72203-1460
UMR
P.O. Box 30541
Salt Lake City, Utah 84130-0541
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Grand Rounds Health
• Personal Healthcare
Assistant for participants in
Illinois, Indiana, Missouri,
North Carolina, South
Carolina, and Virginia
Precedence, Inc. (UnityPoint
Local Plan preauthorizations)
HealthSCOPE Benefits
(Mercy Arkansas, Ochsner,
and UnityPoint Local Plans)
NOTE: Precedence, Inc.
preauthorizes for UnityPoint
Local Plan
Contigo Health
Request a paper copy of this
2022 Associate Benefits Book
855-377-2200
Personal
Healthcare
Assistant
800-361-1492
Go to One.Walmart.com or
healthscopebenefits.com
800-804-1272
HealthSCOPE Benefits
P.O. Box 16367
Lubbock, Texas 79490-6367
877-230-7037
Call People
Services at
800-421-1362
• This chapter generally describes the medical benefits offered under the self‑insured AMP options. See the section titled
The Associates’ Medical Plan (AMP) for information about what it means for an option to be self‑insured.
• In some locations, the AMP also offers health maintenance organization (HMO) and PPO Plan options. Though offered
under the AMP, HMO and PPO Plan options are fully insured and administered separately by the insurer. Terms of coverage
for these options are not described in this chapter. If a fully insured option is available at your work location, coverage details
are described in materials provided separately by the HMO or PPO insurer.
• Some HMOs require participants to accept an arbitration agreement before coverage under the HMO can become effective
and if it is not received by the HMO within 60 days of your enrollment, your HMO coverage will not take effect and you will
not have medical coverage under the AMP unless you have a valid status change event as described in the Eligibility and
enrollment chapter.
• Some programs described in this chapter also are available to participants enrolled in the fully insured PPO Plan option.
For details, see the Helping you manage your health section in this chapter.
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The Associates’ Medical Plan (AMP)
The information in this chapter generally applies to you
if you enroll in the Premier, Contribution, or Saver Plan
option, or the Banner, Mercy Arkansas, Ochsner, or
UnityPoint Local Plan option. These options are referred to,
for purposes of this chapter, as “AMP options.”
The AMP provides medical benefits for you and your
eligible family members through various AMP options. The
AMP options are self‑insured, which means that benefits
provided under the options are not insured by an insurance
company. In other words, an insurance company is not
paying benefits out of its own assets. Instead, you and other
associates enrolled in the AMP options make contributions
(sometimes referred to as “premiums”) through payroll
deductions to cover a portion of the cost of benefits, and
the rest of the cost is paid from company assets or through
a trust funded by the company.
While every AMP option generally provides benefits for
the same covered services, a specific option may have
alternative designs in different locations. The information
in this chapter will explain each AMP option, including
alternative designs, and what you can do to make the most
of the benefits offered to you.
Enrollment
Be sure to enroll by the deadline described in your
enrollment materials!
You will be eligible to enroll in the AMP if you meet the
eligibility conditions described in the chapter titled
Eligibility and enrollment. If you meet the eligibility
conditions, enrollment materials will be mailed to the
address in the company’s records, or if you have elected to
receive benefits materials through electronic delivery, the
enrollment materials will be emailed to you.
WHEN AND HOW TO ENROLL
Don’t confuse the enrollment period with the effective
date of your coverage. The enrollment period is the
time period during which you have to make your benefit
elections. Your coverage effective date is when those
elections take effect. Your specific enrollment period and
effective date will vary depending on a number of factors.
Refer to the chapter titled Eligibility and enrollment and
pay attention to the deadline to enroll that’s stated in the
enrollment materials that you receive. The AMP is not
permitted to make exceptions to let individual associates
enroll after the enrollment period ends so you must enroll
by the deadline or you will have to wait until either the next
Annual Enrollment or you have a status change event. See
the Eligibility and enrollment chapter for details.
The online benefits enrollment tool can be accessed
through One.Walmart.com.
CHOOSING A COVERAGE LEVEL
When you enroll in the AMP, you will select your coverage
level, including any eligible family members you wish to
cover. Coverage levels are:
• Associate only
• Associate + spouse/qualifying partner (not available for
part‑time hourly or temporary associates, or part‑time
truck drivers)
• Associate + child(ren), or
• Associate + family (not available for part‑time hourly or
temporary associates, or part‑time truck drivers).
For information on dependent eligibility, including which
family members may be enrolled for coverage, and when,
see the Eligibility and enrollment chapter.
Role of third-party administrator
The AMP provides medical benefits only for certain
services, which are generally referred to as “covered
services.” Expenses for “covered services” are “eligible
medical expenses.” The AMP administrator has delegated
the fiduciary authority to make claims and appeals
decisions, including prior authorization determinations
where applicable, to several third‑party administrators
(“TPAs”). Your specific TPA will depend on your AMP option
and your work location and in some cases, the type of
services or benefits involved. See the chart below. The TPA
that administers the AMP option you elect is identified on
your plan ID card. The TPA will use its internal policies and
procedures to make claims and appeals decisions on behalf
of the AMP.
Note that TPAs also may be insurance companies that issue
health insurance policies. This does not mean your medical
benefits under the AMP are insured. These insurers also
may serve as TPAs for self‑funded plans. In this case, the
administrator of the AMP has delegated responsibility for
determining claims for benefits under the AMP to the TPA,
which may consult health care professionals to assist in
making claims determinations.
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THIRD‑PARTY ADMINISTRATORS DELEGATED BY PLAN ADMINISTRATOR
Premier, Contribution, and Saver Plan options
Aetna Life Insurance Company (Aetna)
BlueAdvantage Administrators of Arkansas (Blue Advantage)
UMR
Specific TPA depends on your work location
Banner Local Plan option
Aetna
Mercy Arkansas, Ochsner, and UnityPoint Local Plan options
HealthSCOPE Benefits Inc., except that Precedence, Inc.
determines prior authorization requests for the UnityPoint
Local Plan option
Cancer medical record review, outpatient kidney dialysis or
ESRD medical record review, and transplant services under the
Centers of Excellence program
HealthSCOPE Benefits
Heart surgery, spine surgery, hip and knee replacement, and
weight loss surgery under the Centers of Excellence program
Contigo Health
In addition to determining your claims for benefits, the TPA also provides access to its provider network. A provider network
is a group of providers who have each contracted with the TPA and have agreed to accept a negotiated amount for covered
services they provide. That means the total amount of the
eligible medical expenses paid by you and the AMP will not
be more than the negotiated amount. Network providers
are not permitted to bill you for any amount over that
negotiated amount for covered services under the AMP.
AMP options available to you
Generally, the specific AMP options available to you will
depend on your work or assigned‑facility location (“work
location”). If you are a remote worker or are receiving
continuation coverage under COBRA, you will be assigned to
the nearest facility. If you are a truck driver, your plan option
may be determined by your home location rather than work
location. The specific AMP options available to you will be
listed in your enrollment materials and when you enter the
online enrollment system, only these options will be available
for you to choose. Over the next few pages, you will find
charts of the various options that may be available at your work
locations. Each chart provides a summary of coverage for each
AMP option. Immediately following the charts is information
to help you evaluate the option that is right for you.
PREMIER, CONTRIBUTION, SAVER
PLAN OPTIONS
The three main options available to most associates
nationwide are the Premier, Contribution, and Saver Plan
options. The first chart, titled Premier, Contribution,
Saver Plan options — Nationwide, compares these options
side by side and provides coverage information for each
option. Depending on your work location, each of these
options may not be available in your specific area.
The Premier, Contribution, and Saver Plan options may vary
slightly in the actual design in some locations. To make it
easier for you to evaluate the specific AMP options available
to you, immediately following the Premier, Contribution,
Saver Plan options — Nationwide chart, you will see three
charts with those same AMP options but broken down
into specific locations. Whether you will be offered one of
the location‑specific Premier, Contribution, or Saver Plan
options depends on your work location.
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Work locations in the following areas will have location specific
Premier, Contribution, and Saver Plan option designs:
ARKANSAS
• Northwest Arkansas (Benton, Madison, and
Washington counties)
FLORIDA
• Central Florida — including Orlando and Tampa (Brevard,
Citrus, Hernando, Hillsborough, Lake, Manatee, Marion,
Orange, Osceola, Pasco, Pinellas, Polk, northern Sarasota
(Sarasota area only), Seminole, Sumter, and Volusia counties)
• Northeast Florida (Alachua, Baker, Bradford, Clay, Duval,
Flagler, Nassau, Putnam, and St. Johns counties)
OKLAHOMA
• Oklahoma City (Canadian, Cleveland, Lincoln, Logan,
McClain, and Oklahoma counties)
• Tulsa (Creek, Osage, Rogers, Tulsa, and Wagoner counties)
TEXAS
• Dallas/Fort Worth or “DFW” (Collin, Dallas, Denton, Ellis,
Henderson (northwestern), Hunt, Johnson, Kaufman,
Parker, Rockwall, Tarrant, and Wise counties)
• Houston (Austin, Brazoria, Chambers, Fort Bend,
Galveston, Harris, Liberty, Montgomery, and
Waller counties)
• San Antonio (Atascosa, Bexar, Comal, Guadalupe, Kendall,
Medina, and Wilson counties)
The charts applicable to these locations are: Premier,
Contribution, Saver Plan options — northwest Arkansas;
Premier, Contribution, Saver Plan options — central
and northeast Florida; and Premier, Contribution, Saver
Plan options — Oklahoma City, Tulsa, DFW, Houston,
San Antonio.
Unless otherwise indicated throughout this chapter,
references to a “Premier,” “Contribution,” or “Saver”
Plan option will be a reference to the option, generally,
regardless of whether the option is available nationwide
or only in certain locations, unless otherwise specified.
For example:
“Premier Plan option” is a reference to the Premier Plan
option, generally, whether available nationwide or in a
specific location.
“Contribution Plan option/northwest Arkansas” is a
reference to the Contribution Plan option available to
associates with Arkansas work locations in the counties
specified above.
“Saver Plan option/central and northeast Florida” is a
reference to the Saver Plan option available to associates
with Florida work locations in the counties specified above.
“Premier Plan option/Oklahoma and Texas (select counties)”
is a reference to the Premier Plan option available to
associates with Oklahoma or Texas work locations in the
counties listed above.
LOCAL PLAN OPTIONS
If available in your work location, the AMP options also
include “local plans,” which provide access to groups of
providers in a specific area. Agreements between the Plan
and these providers may include financial incentives to
manage care. With limited exceptions, in the designated
areas where a local plan option is available, it will generally
replace the Contribution Plan option as a coverage option if
your work location is in those areas. In other words, if a local
plan is available in an area that includes your work location,
you will be able to choose coverage under the Premier,
Saver, or the available local plan option, but in most of those
areas you will not be able to choose the Contribution Plan.
Local plan options are available in designated regions, as
listed here:
Banner Local Plan
• Phoenix, Arizona metropolitan area
Mercy Arkansas Local Plan
• Portions of northwest Arkansas and McDonald
County, Missouri
Ochsner Local Plan
• New Orleans and Baton Rouge, Louisiana
metropolitan areas
UnityPoint Local Plan
• Portions of Iowa, western Illinois, and Peoria, Illinois area
For details about coverage under the local plan options,
see the chart titled Local plan options — Banner, Mercy
Arkansas, Ochsner, and UnityPoint for additional details.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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PREMIER, CONTRIBUTION, SAVER PLAN OPTIONS — NATIONWIDE
Refer to the charts on the following pages if your work location is in the following areas:
• Central and northeast Florida
• Dallas/Fort Worth, Houston, and San Antonio, Texas; Oklahoma City and Tulsa, Oklahoma
• Northwest Arkansas
Annual deductible
(Individual/Family)
• Network
• Out‑of‑network
Walmart-provided funds
(Individual/Family)
Annual out-of-pocket maximum
(Individual/Family)
• Network
• Out‑of‑network
Eligible preventive care
• Network
• Non‑network
Doctor visits (provider’s office
or telehealth)
Including routine same-day diagnostic tests
performed in doctor’s office
Primary care
• Network
• Non‑network
Specialist
• Network
• Non‑network
Telehealth video visits through
Doctor On Demand
Urgent care
• Network
• Non‑network
Diagnostic tests
Nonpreventive tests ordered or performed
outside a doctor’s office
• Network
• Non‑network
Advanced imaging
MRI and CT scans
• Alternate network
• Network
• Non‑network
Hospitalization
Inpatient & outpatient care
• Network
• Non‑network
Behavioral health
Inpatient & outpatient (facility)
• Network
• Non‑network
Outpatient (provider’s office
or telehealth)
• Network
• Non‑network
Emergency services
Premier Plan
Contribution Plan
Saver Plan
$2,750/$5,500
$5,500/$11,000
N/A
$1,750/$3,500
$3,500/$7,000
$3,000/$6,000
$6,000/$12,000
$250/$500
Maximum annual company
contribution to HRA
$350/$700
Maximum annual company
matching contribution to HSA
$6,850/$13,700
None
$6,850/$13,700
None
$6,650/$13,300
None
100% (no deductible)
50% (no deductible)
100% (no deductible)
50% (no deductible)
100% (no deductible)
50% (no deductible)
100% after $35 copay
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
100% after $75 copay
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
$0 copay
$0 copay
$0 copay after deductible
100% after $75 copay
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
50% after deductible
75% after deductible
50% after deductible
50% after deductible
75% after deductible
50% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
100% after $35 copay
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
100% after deductible
and $300 copay
100% after deductible
and $300 copay
100% after deductible
and $300 copay
For full details regarding emergency services, see later in chapter.
Pharmacy
Centers of Excellence
See The pharmacy benefit chapter
See the Centers of Excellence section of this chapter
Walmart Care Clinic and Walmart Health
See the Walmart Clinics section of this chapter
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PREMIER, CONTRIBUTION, SAVER PLAN OPTIONS — CENTRAL AND NORTHEAST FLORIDA
Premier Plan
Contribution Plan
Saver Plan
Annual deductible
(Individual/Family)
• Network preferred & nonpreferred
• Out‑of‑network
Walmart-provided funds
(Individual/Family)
Annual out-of-pocket maximum
(Individual/Family)
• Network preferred & nonpreferred
• Out‑of‑network
Eligible preventive care
• Network preferred
• Network nonpreferred & non‑network
Doctor visits (provider’s office
or telehealth)
Including routine same-day diagnostic tests
performed in doctor’s office
Primary care
• Network preferred
• Network nonpreferred & non‑network
Specialist
• Network preferred
• Network nonpreferred & non‑network
Telehealth video visits through
Doctor On Demand
Urgent care
• Network preferred
• Network nonpreferred & non‑network
Diagnostic tests
Nonpreventive tests ordered or performed
outside a doctor’s office
• Network
• Non‑network
Advanced imaging
MRI and CT scans
• Alternate network
• Network
• Non‑network
Hospitalization
Inpatient & outpatient care
• Network
• Non‑network
Behavioral health
Inpatient & outpatient (facility)
• Network
• Non‑network
Outpatient (provider’s office
or telehealth)
• Network
• Non‑network
Emergency services
$2,750/$5,500
$5,500/$11,000
N/A
$1,750/$3,500
$3,500/$7,000
$3,000/$6,000
$6,000/$12,000
$250/$500
Maximum annual company
contribution to HRA
$350/$700
Maximum annual company
matching contribution to HSA
$6,850/$13,700
None
$6,850/$13,700
None
$6,650/$13,300
None
100% (no deductible)
50% (no deductible)
100% (no deductible)
50% (no deductible)
100% (no deductible)
50% (no deductible)
100% after $35 copay
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
100% after $75 copay
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
$0 copay
$0 copay
$0 copay after deductible
100% after $75 copay
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
50% after deductible
75% after deductible
50% after deductible
50% after deductible
75% after deductible
50% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
100% after $35 copay
50% after deductible
75% after deductible
50% after deductible
75% after deductible
50% after deductible
100% after deductible
and $300 copay
100% after deductible
and $300 copay
100% after deductible
and $300 copay
For full details regarding emergency services, see later in chapter.
Pharmacy
Centers of Excellence
See The pharmacy benefit chapter
See the Centers of Excellence section of this chapter
Walmart Care Clinic and Walmart Health
See the Walmart Clinics section of this chapter
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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PREMIER, CONTRIBUTION SAVER PLAN OPTIONS — OKLAHOMA CITY, TULSA, DFW, HOUSTON, SAN ANTONIO
The Contribution Plan is available in limited locations in the Dallas/Fort Worth, Houston, San Antonio, and Oklahoma City areas.
Premier Plan
Contribution Plan
Saver Plan
Annual deductible
(Individual/Family)
• Network preferred & nonpreferred
(Network benefits only)
Walmart-provided funds
(Individual/Family)
Annual out-of-pocket maximum
(Individual/Family)
• Network preferred & nonpreferred
(Network benefits only)
Eligible preventive care
• Network preferred
• Network nonpreferred
• Non‑network
Doctor visits (provider’s office
or telehealth)
Including routine same-day diagnostic tests
performed in doctor’s office
Primary care
• Network preferred
• Network nonpreferred
• Non‑network
Specialist
• Network preferred
• Network nonpreferred
• Non‑network
Telehealth video visits through
Doctor On Demand
Urgent care
• Network preferred
• Network nonpreferred
• Non‑network
Diagnostic tests
Nonpreventive tests ordered or performed
outside a doctor’s office
• Network
• Non‑network
Advanced imaging
MRI and CT scans
• Alternate network
• Network
• Non‑network
Hospitalization
Inpatient & outpatient care
• Network
• Non‑network
Behavioral health
Inpatient & outpatient (facility)
• Network
• Non‑network
Outpatient (provider’s office
or telehealth)
• Network
• Non‑network
Emergency services
$2,750/$5,500
$1,750/$3,500
$3,000/$6,000
N/A
$250/$500
Maximum annual company
contribution to HRA
$350/$700
Maximum annual company
matching contribution to HSA
$6,850/$13,700
$6,850/$13,700
$6,650/$13,300
100% (no deductible)
50% (no deductible)
No coverage
100% (no deductible)
50% (no deductible)
No coverage
100% (no deductible)
50% (no deductible)
No coverage
100% after $35 copay
50% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
100% after $75 copay
50% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
$0 copay
$0 copay
$0 copay after deductible
100% after $75 copay
50% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
100% after $35 copay
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
100% after deductible
and $300 copay
100% after deductible
and $300 copay
100% after deductible
and $300 copay
For full details regarding emergency services, see later in chapter.
Pharmacy
Centers of Excellence
See The pharmacy benefit chapter
See the Centers of Excellence section of this chapter
Walmart Care Clinic and Walmart Health
See the Walmart Clinics section of this chapter
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PREMIER, CONTRIBUTION, SAVER PLAN OPTIONS — NORTHWEST ARKANSAS
Annual deductible
(Individual/Family)
• Network
(Network benefits only)
Walmart-provided funds
(Individual/Family)
Annual out-of-pocket maximum
(Individual/Family)
• Network
• (Network benefits only)
Eligible preventive care
• Network
• Non‑network
Doctor visits (provider’s office
or telehealth)
Including routine same-day diagnostic tests
performed in doctor’s office
Primary care
• Network
• Non‑network
Specialist
• Network
• Non‑network
Telehealth video visits through
Doctor On Demand
Urgent care
• Network
• Non‑network
Diagnostic tests
Nonpreventive tests ordered or performed
outside a doctor’s office
• Network
• Non‑network
Advanced imaging
MRI and CT scans
• Alternate network
• Network
• Non‑network
Hospitalization
Inpatient & outpatient care
• Network
• Non‑network
Behavioral health
Inpatient & outpatient (facility)
• Network
• Non‑network
Outpatient (provider’s office
or telehealth)
• Network
• Non‑network
Emergency services
Premier Plan
Contribution Plan
Saver Plan
$2,750/$5,500
$1,750/$3,500
$3,000/$6,000
N/A
$250/$500
Maximum annual company
contribution to HRA
$350/$700
Maximum annual company
matching contribution to HSA
$6,850/$13,700
$6,850/$13,700
$6,650/$13,300
100% (no deductible)
No coverage
100% (no deductible)
No coverage
100% (no deductible)
No coverage
100% after $35 copay
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
100% after $75 copay
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
$0 copay
$0 copay
$0 copay after deductible
100% after $75 copay
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
75% after deductible
50% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
100% after $35 copay
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
100% after deductible
and $300 copay
100% after deductible
and $300 copay
100% after deductible
and $300 copay
For full details regarding emergency services, see later in chapter.
Pharmacy
Centers of Excellence
See The pharmacy benefit chapter
See the Centers of Excellence section of this chapter
Walmart Care Clinic and Walmart Health
See the Walmart Clinics section of this chapter
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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LOCAL PLAN OPTIONS — BANNER, MERCY ARKANSAS,* OCHSNER, UNITYPOINT
Banner
Mercy Arkansas, Ochsner, UnityPoint
Annual deductible
(Individual/Family)
• Network
(Network benefits only)
Walmart-provided funds
(Individual/Family)
Annual out-of-pocket maximum
(Individual/Family)
• Network
• (Network benefits only)
Eligible preventive care
• Network
• Non‑network
Doctor visits (provider’s office
or telehealth)
Including routine same-day diagnostic tests
performed in doctor’s office
Primary care
• Network
• Non‑network
Specialist
• Network
• Non‑network
Telehealth video visits through
Doctor On Demand
Urgent care
• Network
• Non‑network
Diagnostic tests
Nonpreventive tests ordered or performed
outside a doctor’s office
• Network
• Non‑network
Hospitalization
Inpatient & outpatient care
• Network
• Non‑network
Behavioral health
Inpatient & outpatient (facility)
• Network
• Non‑network
Outpatient (provider’s office
or telehealth)
• Network
• Non‑network
Emergency services
Pharmacy
Centers of Excellence
$3,000/$6,000
$1,750/$3,500
N/A
N/A
$6,850/$13,700
$6,850/$13,700
100% (no deductible)
No coverage
100% (no deductible)
No coverage
100% after $35 copay
No coverage
100% after $75 copay
No coverage
100% after $35 copay
No coverage
100% after $75 copay
No coverage
$0 copay
$0 copay
100% after $75 copay
No coverage
100% after $75 copay
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
75% after deductible
No coverage
100% after $35 copay
No coverage
100% after $35 copay
No coverage
100% after deductible and $300 copay
100% after deductible and $300 copay
For full details regarding emergency services, see later in chapter.
See The pharmacy benefit chapter
See the Centers of Excellence section of this chapter
Walmart Care Clinic and Walmart Health
See the Walmart Clinics section of this chapter
* The Mercy Arkansas Local Plan offers limited coverage for chiropractic care office visits. There is a maximum of 10 visits per calendar year.
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Evaluating your options
WALMART-PROVIDED FUNDS
Contribution Plan option — health
reimbursement account
The Contribution Plan option includes a health
reimbursement account (“HRA”). Each year, the company
allocates money to the HRA for you and any covered family
members to use toward your share of the cost of eligible
medical expenses, including those that apply toward your
annual deductible(s) and out‑of‑pocket maximum. You
may not contribute your own money to the HRA. Amounts
contributed by the company are made available only for the
purposes stated below and will be forfeited if you are no
longer enrolled in the Contribution Plan option. The annual
amount allocated to the HRA within the Contribution Plan
option depends on whether you are enrolled in associate‑
only coverage (in which case you will be allocated the
“individual” amount) or a level of coverage that includes
eligible family members (in which case you will be allocated
the “family” amount).
At the beginning of each new year, the company will
allocate that year’s HRA funds to your HRA. The AMP
automatically pays your share of eligible medical expenses
(except for prescription drug expenses) from HRA funds
until the HRA funds are exhausted. Each year’s allocation
of HRA funds may initially be used only for eligible medical
expenses for services that you receive within that year,
except that any balance remaining in your HRA at the end of
the year will roll over for use during the next year, provided
you remain enrolled in the Contribution Plan option. HRA
funds that roll over to the next year are then designated as
“rollover funds.” Your HRA balance (including your allocated
HRA funds for the current year and any amount rolled over
from the previous year) cannot exceed your network annual
deductible under the Contribution Plan option for the
current year.
Only amounts designated as “rollover funds” may be used
to pay for covered services rendered in a previous year.
For example, if you were enrolled in the Contribution
Plan option in 2021 and 2022, any HRA funds allocated in
2022 could be used only for eligible medical expenses for
services received in 2022 but not those received prior to
2022 (such as an expense incurred in 2021 but not processed
until 2022). However, any “rollover funds”—HRA funds that
roll over from 2021 to 2022—may be used for any eligible
medical expense for services received while enrolled in the
Contribution Plan.
If you are hired midyear and enroll in the Contribution Plan,
the company will prorate your initial HRA allocation on a
monthly basis; your annual deductible(s) and out‑of‑pocket
maximum are not prorated. If you have a status change
event, as described in the Eligibility and enrollment
chapter, and change your coverage level midyear from
associate‑only to associate + family coverage, the company
adjusts your HRA allocation, annual deductible(s), and
annual out‑of‑pocket maximum accordingly. However if you
change from associate + family coverage to associate‑only
coverage, amounts previously allocated to your HRA will not
be reduced.
If you cancel your coverage, lose eligibility, or change from
the Contribution Plan option to a different option, any
unused HRA funds are forfeited but will still be available
to pay for eligible medical expenses incurred before you
changed to the different option. If you lose coverage due
to a qualifying event and you continue to be enrolled in the
Contribution Plan option through COBRA continuation
coverage, HRA funds remain available to you under the
terms described above and the company will continue to
allocate funds to your HRA annually as long as you continue
coverage, subject to COBRA’s restrictions on the duration
of continuation coverage. See the COBRA chapter for more
information about COBRA continuation coverage.
Saver Plan option — health savings account
The Saver Plan option gives you the opportunity to
contribute to a health savings account (“HSA”) through
payroll deductions on a pretax basis. The company matches
your payroll deductions into your HSA, dollar‑for‑dollar up
to $350 if you have associate‑only coverage or $700 if you
have elected anything other than associate‑only coverage.
Combined contributions to your HSA (your own and the
company’s) cannot exceed the 2022 annual IRS limit of
$3,650 for associate‑only coverage or $7,300 for all other
coverage levels, plus a $1,000 catch‑up contribution if you
turn 55 by the end of the calendar year.
You can choose to use money in your HSA to pay eligible
medical expenses that are subject to the annual deductible(s),
or you can pay them out of your own pocket and save your
HSA money for future expenses. See the Health savings
account (HSA) chapter for additional information.
COST SHARING
The charts on the prior pages explain how the cost of
covered services is shared between you and the AMP. The
portion of eligible medical expenses you are responsible
for paying is referred to as “cost sharing,” which generally
includes the deductible, copay (or copayment) and
coinsurance amounts that are listed in the coverage
summary charts. Cost sharing does not include any other
expenses, such as amounts for services that are not covered
services or amounts that you pay to a non‑network provider
that are in excess of the maximum allowable charge.
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Annual deductible
Your deductible is the amount of eligible medical expenses
you pay each year for most covered services, including
prescription drugs, before the AMP begins to share in the
cost of covered services. For example, if you have a $1,750
annual network deductible, you will generally need to pay
the first $1,750 of your total eligible medical expenses for
network covered services before the AMP pays any benefit.
The AMP will pay eligible preventive care services and some
covered services in the Premier Plan and Local Plan options
that are subject to a copay (e.g., doctor office visits) before
you meet the applicable annual deductible(s).
Some AMP options have a separate network annual
deductible (for services provided by network providers) and
an out‑of‑network annual deductible (for services provided
by non‑network providers.) In those cases, your share of
eligible medical expenses that apply to the network annual
deductible also apply toward the out‑of‑network annual
deductible, and vice versa. If the AMP option you choose
has a network and out‑of‑network deductible, the AMP
will begin paying a portion of the cost of covered services
from a network provider after you have met the network
annual deductible, but the AMP will generally not pay any
portion of the cost of covered services from a non‑network
provider until the out‑of‑network deductible has been met.
If an AMP option does not cover out‑of‑network services,
you will only have a network annual deductible. In this case,
amounts paid for out‑of‑network services are not eligible
medical expenses and will not count toward your network
annual deductible. (See the Centers of Excellence and
Emergency services sections for limited exceptions.)
All AMP options have an “individual” deductible amount
and a “family” deductible amount. The “individual” amount
is your applicable annual deductible if you have elected
associate‑only coverage. The “family” amount is your
applicable annual deductible if you have elected any
of the other levels of coverage, which include eligible
family members. If you elect coverage for eligible family
members, the deductible(s) can be met by any combination
of you and your covered family members, but no benefits
are payable, except for services not subject to a deductible,
for either you or your covered family members until the
entire applicable (network or out‑of‑network) annual
deductible is met.
If you are enrolled in the Contribution Plan option: You can
meet your annual deductible with your company‑provided
HRA funds allocated in the current year and any rollover
HRA funds you may have from a previous year. When you
have used all your HRA funds, you must use your own funds
to meet the remainder of your annual deductible.
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If you are enrolled in the Saver Plan option: You
generally must pay full cost for covered services and
prescription drugs until you meet your network annual
deductible. There are exceptions (some preventive and
over‑the‑counter drugs and preventive services), which
are discussed below and in The pharmacy benefit chapter.
The following expenses, if applicable to a specific option,
do not count toward the network or out‑of‑network
annual deductible(s).
• Copays for pharmacy, in‑person or telehealth doctor visits,
urgent care, Walmart Care Clinic or Walmart Health, or
covered services for a non‑emergency medical condition
in an emergency department
• Coinsurance for pharmacy and for hip or knee replacement
services outside the Centers of Excellence program
without an exception
• Discounts, coupons, pharmacy discount programs or
similar arrangements provided by drug manufacturers
or pharmacies to assist you in purchasing prescription
drugs (including any prescription drug charges paid
directly to pharmacies on your behalf through discount
programs/coupons)
• Amounts in excess of the maximum allowable charge that
you pay to non‑network providers, including but not limited
to amounts paid for services for a non‑emergency medical
condition in an emergency department, amounts paid to a
provider subject to notice and consent requirements who
has obtained your consent to bill you for amounts in excess
of the maximum allowable charge, and amounts you pay
to a non‑network provider of air ambulance services for
services that would not be covered by the AMP if provided
by a network provider of air ambulance services
• Charges for services (other than copays, discussed above)
provided at any non‑network Walmart Care Clinic or
Walmart Health (however, amounts for covered diagnostic
tests performed outside the Walmart Care Clinic or
Walmart Health will be subject to otherwise applicable
AMP terms, including other exclusions in this list)
• Charges for services not covered by the AMP, including
amounts paid for out‑of‑network services if you are in an
AMP option that does not cover out‑of‑network services
• Charges paid 100% by the AMP, such as charges for
preventive services (including preventive drugs) and
certain Centers of Excellence services
• Charges for non‑network preventive services, and
• Premiums.
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Copayments
A “copay” (or “copayment”) is a fixed amount that you pay
for a covered service or prescription drug and is usually
paid when you receive the service or fill a prescription.
For covered services subject to a copayment, you must
continue to pay the copayment, even after your applicable
annual deductible has been met, until you meet your annual
out‑of‑pocket maximum.
NOTE: The AMP benefit for non‑office
provider visits (e.g., inpatient visit or surgical
services) is 75%, after deductible, for network
providers (or for Premier, Contribution, Saver
Plan options in central and northeast Florida
and Oklahoma and Texas (select counties), 75%,
after deductible, for preferred providers); and
50%, after deductible, for non‑network and
nonpreferred providers (if applicable).
Coinsurance
For most covered services not subject to a copayment, you
will be required to share the cost of covered services with
the AMP after you meet your applicable annual deductible.
The portion you pay is called “coinsurance.”
The charts that contain the coverage summaries show the
percentage that the AMP will pay for covered services,
which varies depending on the status of the provider.
• Premier, Contribution, and Saver Plan options/nationwide:
These AMP options will generally pay a greater portion
of the cost of covered services received from a network
provider than those received from a non‑network provider.
Always check the provider directory to find network
providers: GrandRounds.com/Walmart.
• Premier, Contribution, and Saver Plan options/central
and northeast Florida: For some services, the AMP
benefit under these options depends not only on whether
the provider is a network provider, but on whether the
provider is a preferred network provider or a nonpreferred
network provider. Preferred providers and nonpreferred
providers are both network providers. However, under
these options, the AMP will generally pay a greater
portion of the cost of covered services received from a
preferred provider than those received from a nonpreferred
provider. The AMP also pays a portion of the cost of
covered services received from a non‑network provider
under these options but it will always be a smaller portion
than the AMP pays for covered services received from
a preferred or nonpreferred network provider. And, when
you receive services from a non‑network provider, you
will generally be responsible for the cost of services in
excess of the AMP’s maximum allowable charge except in
the case of covered services for an emergency medical
condition in an emergency department or certain services
provided by a non‑network provider in a network facility
that has not obtained your consent to bill you. See the
section titled Provider networks for a discussion of the
difference between a network provider and a non‑network
provider. Find preferred providers in the provider directory:
GrandRounds.com/Walmart.
• Premier, Contribution, and Saver Plan options/Oklahoma
and Texas (select counties): The AMP does not provide
coverage for services received from a non‑network
provider under these options, other than covered services
for an emergency medical condition in an emergency
department or certain services provided by a non‑network
provider in a network facility that has not obtained your
consent to bill you. (See the Centers of Excellence and
Emergency services sections for limited exceptions.)
• Other than the services described above, the AMP only
pays a portion of the cost of covered services when those
services are received from a network provider under
these options. The AMP benefit depends on whether the
provider is a preferred network provider or a nonpreferred
network provider. Preferred providers and nonpreferred
providers are both network providers. However, the AMP
will generally pay a greater portion of the cost of covered
services received from a preferred provider than those
received from a nonpreferred provider. Except for the
circumstances described above, you will be responsible
for the entire amount billed by a non‑network provider.
See Provider networks for a discussion of the difference
between a network provider and a non‑network provider.
Find preferred providers in the provider directory:
GrandRounds.com/Walmart.
• Premier, Contribution, and Saver Plan options/northwest
Arkansas: The AMP does not provide coverage for services
received from a non‑network provider under these
options, other than covered services for an emergency
medical condition in an emergency department or certain
services provided by a non‑network provider in a network
facility that has not obtained your consent to bill you.
(See the Centers of Excellence and Emergency services
sections for limited exceptions.)
Other than the services described above, the AMP only
pays a portion of the cost of covered services when those
services are received from a network provider under
these options. Except for the circumstances described
above, you will be responsible for the entire amount billed
by non‑network provider. See Provider networks for a
discussion of the difference between a network provider
and a non‑network provider. Find network providers in the
provider directory: GrandRounds.com/Walmart.
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• Local plan options: These AMP options do not provide
coverage for services received from a non‑network
provider, other than covered services for an emergency
medical condition in an emergency department or certain
services provided by a non‑network provider in a network
facility that has not obtained your consent to bill you.
Other than the services described above, the AMP only
pays a portion of the cost of covered services when those
services are received from a network provider under
these options. Except for the circumstances described
above, you will be responsible for the entire amount billed
by non‑network provider. See Provider networks for a
discussion of the difference between a network provider
and a non‑network provider. Find network providers in the
provider directory: GrandRounds.com/Walmart.
For all AMP options other than the local plan options, if
your covered services include an MRI or CT scan, the AMP
will pay a greater portion of the cost of covered services
received from an alternate network provider than a network
provider. If no alternate network provider is available in your
area, you will receive the alternate network AMP benefit if
you use a network provider. See Advanced imaging network
in the Provider networks section for more information.
The portion that you and the AMP each pay is not calculated
based on the provider’s billed charges. It is calculated as
a percentage of the maximum amount the AMP will allow
for a covered service, also referred to as the “maximum
allowable charge,” or “MAC.” Generally, if your AMP
option includes out‑of‑network coverage and you receive
services from a non‑network provider (other than covered
services for a non‑emergency medical condition in an
emergency department and certain covered services from
a non‑network provider at a network facility that has not
obtained your consent to bill you) you will be responsible for
paying not only cost‑sharing amounts but also any amounts
in excess of the maximum allowable charge. Network
providers will not bill you for covered services in excess of
the maximum allowable charge. See the What is covered by
the AMP section later in this chapter for more information
about the maximum allowable charge.
Annual out-of-pocket maximum
The annual out‑of‑pocket maximum amount is the most
you could pay during the calendar year for your share
of the costs of covered services provided by network
providers. After you meet this limit the AMP generally
pays 100% of the maximum allowable charge. Not every
cost you pay for health care will go toward the out‑
of‑pocket maximum. It never includes your premium,
amounts billed by a non‑network provider that are above
the maximum allowable charge, or amounts for services
the plan doesn’t cover. The out‑of‑pocket maximum
only applies to network services. There is no annual
out‑of‑pocket maximum for services from non‑network
providers—you are responsible for paying your share of
these charges for the rest of the year, even after you have
met the network annual out‑of‑pocket maximum.
The AMP option you choose has an individual out‑of‑pocket
maximum and a family out‑of‑pocket maximum. Regardless
of the coverage level you choose, you and each of your
covered family members is subject to the individual
out‑of‑pocket maximum. Once you or any of your covered
family members have incurred charges for network
covered services up to that amount, that individual’s
eligible medical expenses are paid at 100% for the rest
of the calendar year. The family out‑of‑pocket maximum
is a combination of all family members’ eligible medical
expenses from network providers. Any combination of
two or more family members can contribute to meet the
family out‑of‑pocket maximum. Once you meet the total
family out‑of‑pocket maximum, eligible network expenses
for your entire family are paid at 100% for the rest of the
calendar year, even if each individual has not met the
individual out‑of‑pocket maximum.
The following expenses, if applicable to a specific option,
do count toward the annual out‑of‑pocket maximum:
• Amounts paid toward your annual network and
out‑of‑network deductible
• Copays for in‑person or telehealth doctor visits, urgent
care, non‑network Walmart Care Clinic or Walmart Health,
or covered services that are emergency services for an
emergency medical condition in an emergency department
• Coinsurance for services provided by a network provider
or by a non‑network provider that the Plan pays as
in‑network
• Pharmacy copays/coinsurance.
The following expenses, if applicable to a specific option,
do not count toward the annual out‑of‑pocket maximum:
• Charges paid 100% by the AMP such as charges for
network preventive services and certain Centers of
Excellence services and network providers of hip or knee
replacement services outside of the Centers of Excellence
program without an exception
• Charges for non‑network preventive services
• Coinsurance when using non‑network providers
• Amounts in excess of the maximum allowable charge
that you pay to non‑network providers, including
but not limited to amounts paid for services for a
non‑emergency medical condition in an emergency
department, amounts paid to a provider subject to
notice and consent requirements who has obtained your
consent to bill you for amounts in excess of the maximum
allowable charge, and amounts you pay to a non‑network
provider of air ambulance services for services that
would not be not covered by the AMP if provided by a
network provider of air ambulance services
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• Copays and charges for services provided at any
non‑network Walmart Care Clinic or Walmart Health
(however, amounts for covered diagnostic tests
performed outside the Walmart Care Clinic or Walmart
Health will be subject to otherwise applicable AMP terms,
including other exclusions in this list)
• Discounts, coupons, pharmacy discount programs, or
similar arrangements provided by drug manufacturers or
pharmacies to assist you in purchasing prescription drugs
(including prescription drug discount/coupons provided to
pharmacies when you fill a prescription)
• Charges for services not covered by the AMP, including
amounts paid for out‑of‑network services if you are
in an AMP option that does not cover out‑of‑network
services, and
• Premiums.
Provider networks
The AMP contracts with your third‑party administrator to
provide a network of health care providers from whom you
can receive covered services under the AMP at discounted
prices. See the TPA networks section below. Although the
company and the Plan seek to utilize providers and provider
networks that provide quality care, neither the company nor
the Plan make any representations regarding the quality of
services you will receive from any provider. The AMP does
not furnish hospital or medical services and is not liable
for any act or omission of any provider or agent of such
provider, including failure or refusal to render services. All
medical decisions are between you and your provider.
A network provider is, generally, a provider who has agreed
to accept a contracted amount as full payment for covered
services. Each AMP option has a specific group of providers
who have agreed with the TPAs to accept a contracted
price—that is generally your network. However, the AMP
also has networks that are specific to covered services
offered by the AMP, such as those under the Centers of
Excellence program or advanced imaging services (MRI
and CT scans), with their own rules. In addition, some AMP
options have preferred and nonpreferred network providers.
Both are network providers, but the AMP pays a greater
benefit when you use a preferred network provider. In any
case, you will typically pay less when seeing a network
provider. Network providers may not bill you for amounts in
excess of the contracted price for the service.
A non‑network provider is one who has not agreed to
accept a contracted amount as full payment for covered
services. With some exceptions, non‑network providers are
permitted to bill you for amounts in excess of the amount
paid by the AMP. This is why you can typically expect to pay
more when you see a non‑network provider.
When the AMP pays an amount for covered services,
neither the AMP’s portion nor your portion is based on the
amount billed by the provider, but rather on the “maximum
allowable charge.” The maximum allowable charge is the
maximum charge for covered services that the AMP will
pay in whole or part, subject to copayments, deductibles
and coinsurance amounts. The maximum allowable charge
for network providers and non‑network providers is
determined in a different way. For network providers, the
maximum allowable charge is the amount network providers
have agreed to accept as full payment for covered services.
The maximum allowable charge for non‑network providers
is generally determined by the AMP. With some exceptions,
non‑network providers can bill you for amounts in excess
of the maximum allowable charge determined by the AMP.
See Maximum allowable charge in the What is covered
by the AMP section later in this chapter for detailed
information about how the AMP determines the maximum
allowable charge for non‑network providers.
The AMP, its third‑party administrators, and network
providers may agree to certain incentive arrangements
(which may pay bonuses or withhold provider payments)
designed to reward high‑quality and cost‑effective
treatments. Some of the local plan contracts include such
arrangements. Contact your third‑party administrator for
information regarding these arrangements.
The sections below discuss the various networks used by
the AMP.
TPA NETWORKS
Depending on your work location and choice of AMP
option, your benefits under the AMP are administered by
one of the following third‑party administrators:
• Aetna
• BlueAdvantage Administrators of Arkansas
– If your work location is in the District of Columbia,
Florida, Georgia, Maryland, northern Virginia, Minnesota,
Missouri (Kansas City area), New Hampshire, New Jersey,
Oklahoma, Pennsylvania, Tennessee, or Wisconsin, see
important information below in the section titled Blue
Select networks through BlueAdvantage Administrators
of Arkansas.
• HealthSCOPE Benefits
• UMR
• Mercy Health Communities
• UnityPoint
• Ochsner
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If your provider leaves the network prior to your receiving
services, services provided by that provider are generally
treated as out‑of‑network services. If your AMP option
provides out‑of‑network coverage, and you receive services
from a non‑network provider, you will generally be responsible
for the cost of services in excess of the AMP’s maximum
allowable charge. If your AMP option does not provide
out‑of‑network coverage, you will generally be responsible
for the entire amount charged by the non‑network provider.
See important information about continuity of care services
described in the section titled When network benefits are
paid for out-of-network services on the following page.
Find network providers at GrandRounds.com/Walmart.
BLUE SELECT NETWORKS THROUGH
BLUEADVANTAGE ADMINISTRATORS
OF ARKANSAS
If you are in an AMP option and BlueAdvantage Administrators
of Arkansas is your third‑party administrator, you may have
more narrow networks—called Blue Select Networks—if
your work location is in a particular service area. In these
locations, you must use a provider in the Blue Select
Network for network terms—i.e., network annual deductibles
and network coinsurance—to apply. If your work location is in
one of the areas below, services provided by providers who
are not in the Blue Select Networks will be treated as out‑
of‑network services. You can find providers who are in your
Blue Select Network, listed below, by accessing the Provider
Directory at GrandRounds.com/Walmart. Your plan ID card
will also identify your specific network.
If your work location is not in one of the areas listed below
but you receive services in one of these areas, (e.g., you are
traveling in one of these areas), you may use any network
provider, including those not in the Blue Select Networks.
If BlueAdvantage Administrators of Arkansas is your
third‑party administrator, you must access the Blue Select
Network for services to be treated as in‑network if your
work location is in one of the following areas:
• Florida: NetworkBlueSM
• Georgia: Blue Open Access POS
• Maryland, Northern Virginia, District of Columbia:
BlueChoice Advantage Open Access
• Minnesota: High Value Network
• Missouri (Kansas City): Preferred‑Care Blue
• New Hampshire: BlueChoice Open Access POS
• New Jersey: Horizon Managed Care Network
• Oklahoma: BluePreferred
• Pennsylvania: Community Blue Network
• Tennessee: Network S
• Wisconsin: Blue Preferred POS
For information about the Blue Select Networks, call your
health care advisor at the number on your plan ID card.
CENTERS OF EXCELLENCE
See the Centers of Excellence section for information
about network requirements when covered services include
the following:
• Surgeries for certain heart conditions
• Surgeries for certain spine conditions
• Hip replacement surgery
• Knee replacement surgery
• Medical record review by a Centers of Excellence facility
for certain types of cancer (all ages) to determine if an
on‑site evaluation is recommended; eligible types of
cancer are breast, colorectal, lung, prostate, and blood
(including myeloma, lymphoma, and leukemia)
• Medical record review by a Centers of Excellence facility
for outpatient kidney dialysis or end‑stage renal disease
(ESRD) (all ages) to determine if an on‑site evaluation for
kidney transplant evaluation is recommended
• Liver, kidney, heart (including durable ventricular assist
devices [VADs] and total artificial hearts), lung (including
lung volume reduction surgery [LVRS]), pancreas,
simultaneous kidney/pancreas, multiple organ, and bone
marrow/stem cell transplants (including CAR T‑cell
treatment), and
• Weight loss surgeries including gastric bypass, gastric
sleeve, and duodenal switch.
ADVANCED IMAGING NETWORK
If you participate in the Premier, Contribution, or Saver
Plan options, an alternate network of providers for
advanced imaging services (MRI and CT scans) may
be available to you. The AMP benefit for advanced
imaging services will depend on whether the provider
is an alternate network provider, a network provider, or
a non‑network provider. In the context of advanced
imaging services, alternate network providers and network
providers are both network providers for purposes of
understanding whether expenses you pay go to your
deductible and annual out‑of‑pocket maximum. However,
the AMP will generally pay a greater portion of the cost
of covered services received from an alternate network
provider than those received from a network provider. The
AMP option also pays a portion of the cost of covered
services received from a non‑network provider, if your
AMP option covers out‑of‑network services, but it will
always be a smaller portion than the AMP pays for covered
services received from an alternate network provider or
network provider. And, when you receive services from a
non‑network provider, you will be responsible for the cost
of services in excess of the AMP’s maximum allowable
charge. If your AMP option does not cover out‑of‑network
services, you will be responsible for the entire amount
billed by the non‑network provider. See Provider networks
for a discussion of the difference between a network
provider and a non‑network provider. Preauthorization
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is required. If no alternate network provider is available,
the AMP will pay the alternate provider rate for covered
services received from a network provider. Your health
care advisor will assist you with any questions and can be
reached at the number on your plan ID card.
WHEN NETWORK BENEFITS ARE PAID FOR
OUT-OF-NETWORK SERVICES
In some cases, services you receive from a non‑network
provider may be treated as services received from a
network provider. In that case, the AMP will pay in‑network
benefits, based on the maximum allowable charge for
non‑network benefits, generally subject to applicable
AMP terms. Amounts you pay for covered services will
be subject to rules applicable to covered services from
a network provider. For emergency services and certain
services received in a network facility from a non‑network
provider, such as anesthesia, pathology, radiology,
laboratory, neonatology, assistant surgeon, hospitalist, or
intensivist services, you will not be responsible for amounts
in excess of the maximum allowable charge. If you receive
other services at these network facilities, non‑network
providers cannot balance bill you, unless you give written
consent. In most other cases, you will still be responsible
for any amounts in excess of the maximum allowable
charge. In some cases, you may have to pay for treatment
when you receive it and file a claim for reimbursement.
Out‑of‑network covered services will be treated as network
covered services in the following circumstances:
• If your dependent child under age 19 requires treatment at
a Children’s Miracle Network hospital.
• If there are no network providers with the relevant
specialty within 30 miles of your home (not applicable to
local plan options).
• Services for treatment received while on vacation or
business travel in the U.S., where such treatment either
could not have reasonably been foreseen prior to the
travel or the course of treatment began prior to the
travel and for medical reasons must be continued during
such travel.
• If you are undergoing a course of treatment for a
serious and complex condition, undergoing a course of
institutional or inpatient care, scheduled to undergo
nonelective surgery, or determined to be terminally ill,
services from a non‑network provider are treated as
network services until the effective date of the next
Annual Enrollment, or 90 days after you are notified that
the provider is no longer a network provider, whichever
is later; provided the course of treatment began when
the provider was a network provider and there is no
interruption of the doctor/patient relationship (for
example, if you change third‑party administrators during
the year because of a change in work location and are in
the middle of a course of treatment).
• If you are pregnant and undergoing a course of treatment
for the pregnancy, services from a non‑network provider
are treated as network charges for 90‑days after you are
notified that the provider is no longer a network provider or
six weeks after delivery, whichever is later; provided services
began when the provider was a network provider and there
is no interruption of the doctor/patient relationship.
• Services from a non‑network provider treated as services
from a network provider until the next Annual Enrollment,
when coverage under the AMP is added and utilizing a
non‑network provider in a course of treatment begun prior
to effective date, where there is no interruption of the
doctor/patient relationship.
In the following instances, applicable law requires that the
non‑network provider will not be permitted to bill you for
the difference between the provider’s billed charges and
the AMP’s maximum allowable charge:
• If you receive emergency services from a non‑network
provider or a non‑network emergency department
• If you receive services from a non‑network provider at
a network health care facility and have not given the
non‑network provider permission to bill you for the
difference between the billed amount and the maximum
allowable charge
• If you receive services from a non‑network provider of
air ambulance services that would be covered services
under the AMP if provided by a network provider of air
ambulance services
In addition, with respect to transport by ambulance (other
than air ambulance), out‑of‑network covered expenses
may be treated as network covered expenses. The amounts
paid by the AMP for ambulance are based on up to 200%
of the maximum allowable charge if you are directly
admitted to the hospital from an emergency department
or pass away prior to hospital admission. Amounts in
excess of 200% of the maximum allowable charge are
your responsibility and do not count toward your annual
deductible or out‑of‑pocket maximum. For information
about air ambulance coverage, call your health care
advisor at the number on your plan ID card.
With respect to transport by out‑of‑network air ambulance
services, out‑of‑network covered services will be treated
as network covered expenses. Your cost‑sharing will be the
same as for network air ambulance services and the amount
on which your cost‑sharing percentage is calculated will
be based on the billed amount or the amount calculated
under the Employee Retirement Income Security Act of
1974 (“ERISA”), whichever is less. The amounts paid by the
AMP for out‑of‑network air ambulance services will be the
amount negotiated by the AMP or the amount determined
by the independent dispute resolution process required
under ERISA. Under applicable law, the non‑network air
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ambulance provider will not be permitted to bill you for
the difference between the billed charges and the AMP’s
maximum allowable charge.
Detailed information about what services are preventive
services can be found in the Preventive care program section.
COVERAGE WHEN YOU TRAVEL TO A
FOREIGN COUNTRY
If you travel abroad, follow these steps:
• Before you begin your travel, contact your
third‑party administrator for details about
medical coverage and emergency medical
services when traveling abroad. Coverage
outside the United States may vary.
• Always carry your plan ID card with you
when you travel and present it when you
receive medical services.
PREVENTIVE SERVICES
The AMP will pay all or a portion of the cost of covered
preventive services before you meet your applicable
deductible according to the following terms:
• If you are enrolled in the Premier, Contribution, Saver Plan
options/nationwide: the AMP will pay 100% of the cost
of covered preventive services received from a network
provider. If the provider is non‑network provider, the AMP
will pay 50% of the cost of covered services, and amounts
you pay will not go toward your deductible or out‑of‑
pocket maximum.
• If you are enrolled in the Premier, Contribution, Saver
Plan options in central and northeast Florida or Oklahoma
and Texas (select counties), the AMP will pay 100% of
the cost of covered preventive services received from a
preferred network provider. If the provider is a nonpreferred
network provider (or a non‑network provider in central
and northeast Florida), the AMP will pay 50% of the
cost of covered preventive services. Amounts paid for
covered preventive services from a nonpreferred network
provider will count toward your network deductible and
out‑of‑pocket maximum but amounts paid for preventive
services from a non‑network provider will not. Only central
and northeast Florida have out‑of‑network coverage.
• If you are enrolled in the Premier, Contribution, Saver
Plan options/northwest Arkansas: the AMP will pay 100%
of the cost of covered preventive services received from
a network provider. This AMP option does not provide
out‑of‑network coverage.
If your AMP option provides out‑of‑network coverage, and
covered preventive services are provided by a non‑network
provider, you are also responsible for any amount above the
maximum allowable charge.
TELEHEALTH VIDEO VISITS THROUGH
DOCTOR ON DEMAND
You have access to Doctor On Demand, a telehealth
service offering video medical (including urgent care) and
behavioral health visits. Doctor On Demand doctors can
diagnose, treat, and write prescriptions for a wide range of
non‑emergency medical issues. The service is available in all
50 states, 24 hours a day, seven days a week by computer,
tablet, or smartphone. You will need to download the
Doctor On Demand app from the App Store or Google Play.
Doctor On Demand is available at no cost for most
AMP options. If you are in the Saver Plan option, you
must first meet your network deductible, after which
Doctor On Demand visits are available at no cost to
you. For information about services and technical
requirements, visit Doctor On Demand online at
DoctorOnDemand.com/Walmart or call 800-997-6196.
Telehealth services outside of Doctor On Demand will be paid
under the otherwise applicable AMP terms (for example, the
same as outpatient doctor visits), as allowed by the AMP.
EMERGENCY SERVICES
Benefits for emergency services are an important part of
your AMP coverage. However, it’s important that you know
how those benefits work and in what circumstances benefits
will be paid. When you seek treatment in an emergency
department for services that are not “emergency services”
for an “emergency medical condition,” your out‑of‑pocket
costs could be significant, especially if the facility or
provider is not in your AMP option’s network. Please review
this section carefully.
The plan will pay the benefit described below for
emergency services. Generally, the law defines “emergency
services” to include an appropriate medical screening in
an emergency department of a hospital or an independent
freestanding emergency department to evaluate an
“emergency medical condition.” An “emergency medical
condition” means a medical condition, including a mental
health condition or substance use disorder, manifesting
itself by acute symptoms of sufficient severity such that
a prudent layperson with an average knowledge of health
and medicine could reasonably expect that the absence
of immediate medical attention would (i) place the health
of the individual (or, with respect to a pregnant woman,
the health of the woman or her unborn child) in serious
jeopardy; (ii) result in serious impairment to bodily
functions; or (iii) result in serious dysfunction of any bodily
organ or part.
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The emergency department copay is $300 per visit,
whether you visit a network facility or not (unless you are
admitted to the hospital from the emergency department
or pass away prior to admission). This copay is in addition
to your annual deductible and must be paid even after you
have met your annual deductible.
If services you receive in an emergency department are
“emergency services,” the AMP will pay the cost of covered
services as in‑network benefits, which is 100% after you
have met your network deductible and paid the $300
copay, even if the emergency department or provider is
a non‑network provider or facility. The AMP payment to
a non‑network provider or facility will be based on the
amount negotiated by the AMP or the amount determined
by the independent dispute resolution process required
under the Employee Retirement Income Security Act
of 1974. The non‑network provider or facility will not be
permitted to bill you for the difference between the billed
amount and the amount paid by the AMP.
If, after a retrospective review, when deciding your post‑
service claim, the third‑party administrator determines
that a prudent layperson would not consider the medical
condition to have been an emergency medical condition,
services will be subject to all applicable AMP terms. If your
AMP option has out‑of‑network coverage, the AMP will pay
50% of the maximum allowable charge for covered services
after you have met your out‑of‑network deductible and
you will be responsible for paying the deductible, the copay
of $300, the coinsurance and amounts in excess of the
maximum allowable charge for medical services provided in
the emergency department of a non‑network facility. If you
are enrolled in the Premier, Contribution, Saver Plan options
in Oklahoma and Texas (select counties) or northwest
Arkansas, the AMP will pay 50% of the maximum allowable
charge for covered services after you have met your
network deductible, the copay of $300, the coinsurance,
and amounts in excess of the maximum allowable charge.
If you are in a local plan option, services received from a
non‑network provider or facility will not be paid by the
AMP and you will be responsible for the entire amount. You
will be able to appeal the TPA’s determination under the
post‑service claims procedures described in the Claims and
appeals chapter.
If the provider or facility is a network facility, the AMP
will pay 100% of covered services after you have met your
annual deductible, regardless of whether the third‑party
administrator determines that the visit is for an “emergency
medical condition,” subject to the $300 copay.
Centers of Excellence
The Centers of Excellence program works with specific
facilities to provide covered services related to a range of
conditions and illnesses. Through this program, you and
your covered family members have access to specialized
providers and facilities selected for their expertise in
certain complex procedures. The Centers of Excellence
program covers:
• Surgeries for certain heart conditions (age 18 and up)
• Surgeries for certain spine conditions (age limitations
apply to some spine conditions, such as scoliosis)
• Hip replacement surgery
• Knee replacement surgery
• Medical record review by a Centers of Excellence facility
for certain types of cancer (all ages) to determine if an on‑
site evaluation is recommended; eligible types of cancer
are breast, colorectal, lung, prostate, and blood (including
myeloma, lymphoma, and leukemia)
• Medical record review by a Centers of Excellence facility
for outpatient kidney dialysis or end‑stage renal disease
(ESRD) (all ages) to determine if an on‑site evaluation for
kidney transplant evaluation is recommended
• Liver, kidney, heart (including durable ventricular assist
devices [VADs] and total artificial hearts), lung (including
lung volume reduction surgery [LVRS]), pancreas,
simultaneous kidney/pancreas, multiple organ, and bone
marrow/stem cell transplants (including CAR T‑cell
treatment), and
• Weight loss surgeries including gastric bypass, gastric
sleeve, and duodenal switch (age 18 and up).
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As shown in the Centers of Excellence chart below, certain covered services performed at one of the Centers of Excellence
facilities included in the program are covered at 100% with no annual deductible (excluding weight loss surgery). However, if
you are enrolled in the Saver Plan, you must meet your annual network deductible before the AMP will pay any benefits.
The chart below is a summary only. Read all of the information in this section to understand all Centers of Excellence
program requirements and restrictions, including when exceptions may apply.
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CENTERS OF EXCELLENCE
Heart surgery
(Cardiac valve repair/replacement
requires a cardiac valve eReview
by Cleveland Clinic)
Cancer medical record review
with on‑site evaluation
if recommended
Eligible cancer types: breast,
colorectal, lung, prostate,
blood (including myeloma,
lymphoma, leukemia)
Outpatient kidney dialysis or
ESRD medical records review with
on‑site kidney transplant evaluation
if recommended
Hip and knee replacement
Centers of Excellence Program
Outside of Centers of Excellence Program
100%
No deductible*
Regular AMP benefits apply
100%
No deductible*
Premier, Contribution, Saver Plan options in areas other
than central and northeast Florida; Oklahoma and Texas
(select counties) and northwest Arkansas:**
50% after out‑of‑network deductible
Coinsurance will not apply to out‑of‑pocket maximum
Premier, Contribution, Saver Plan options in central and
northeast Florida; Oklahoma and Texas (select counties)
and northwest Arkansas:**
50% after network deductible if you use a preferred network
provider (or in northwest Arkansas, a network provider)
Coinsurance will not apply to out‑of network deductible,
if applicable, or out‑of‑pocket maximum
No coverage*** for nonpreferred network provider,
where applicable, or non‑network provider
Spine surgery
Transplant (Mayo Clinic only. Excludes
cornea and intestinal transplant)
100%
No deductible*
100%
No deductible*
Weight loss surgery (Gastric bypass,
gastric sleeve, and duodenal switch)
75%
After network deductible
Local plans:
No coverage***
No coverage***
No coverage***
No coverage***
* Participants in the Saver Plan option must meet their network annual deductible before the AMP pays any benefits.
** See AMP options available to you, earlier in this chapter for the specific counties included in these areas.
*** Exceptions may apply. See the section titled Requests for exceptions to coverage terms for spine surgery and hip and knee replacement.
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If you believe you may be a candidate for Centers of
Excellence services, call your health care advisor at the
phone number on your plan ID card. If you qualify, you
will be connected to the Centers of Excellence program
administrator to begin the scheduling process. To
participate in the Centers of Excellence program:
• Services must be preauthorized by one of the
administrators for the Centers of Excellence program.
The specific administrator from whom preauthorization
must be obtained varies, depending on the service to be
provided and your AMP option, as listed in the Centers of
Excellence administration chart on this page.
• Your preauthorization claim will be a pre‑service claim
(or urgent claim, if applicable), as described in the Claims
and appeals chapter. If your request for preauthorization
of a Centers of Excellence service is denied, you have the
right to appeal. See the Claims and appeals chapter for
information. Note that services performed at a Centers of
Excellence facility that are not covered services under the
terms and conditions of the Centers of Excellence program
are subject to regular coverage terms under the AMP.
• For most covered services, you must identify a
designated caregiver who is willing and able to meet
caregiver requirements.
• For most covered services, you must be able to safely
travel for medical care and must not require emergency
care at the time of travel.
• The medical center where you receive services is
determined by where you live and the indicated service.
• You acknowledge that the medical center must receive
necessary medical records prior to your acceptance into
the program.
• You must supply contact information for a local physician
who has agreed to manage your follow‑up care after you
return home from the Centers of Excellence facility.
• You must certify that your injury will not result in litigation
with a third party, is not subject to the Plan’s subrogation
and reimbursement rights as described in the Claims
and appeals chapter, and is not a compensable injury, as
defined by applicable workers’ compensation law.
• You acknowledge that you, your caregiver, and any visitors
must abide by all rules and policies of the hotel, transport
service, and Centers of Excellence facility, including those
that apply to onsite conduct. Failure to do so may result
in loss of eligibility for benefits under the Centers of
Excellence program.
• If you are covered by more than one medical plan, the
AMP must be the primary plan.
CENTERS OF EXCELLENCE ADMINISTRATION
NOTE: If you are enrolled in a local plan, call your health care
advisor to be directed to the appropriate administrator.
Heart surgery
Contigo Health
Cancer medical record review (onsite
travel if recommended)
HealthSCOPE
Benefits
Outpatient kidney dialysis or ESRD
medical record review
HealthSCOPE
Benefits
Spine surgery
Hip and knee replacement
Contigo Health
Contigo Health
Transplant (Mayo Clinic only. Excludes
cornea and intestinal transplant)
HealthSCOPE
Benefits
Weight loss surgery (gastric bypass,
gastric sleeve, and duodenal switch)
Contigo Health
Travel, lodging, and a daily allowance are provided for you
and a caregiver for all services covered under the Centers
of Excellence program except weight loss surgery. These
travel services must be pre‑approved and scheduled through
the Centers of Excellence program. Payment is subject to
applicable limits and is taxable. (Travel benefits may not be
available if you are enrolled in one of the local plan options.)
Specialized care benefit: In some cases, the AMP may
consult with Grand Rounds Health to determine whether
services you need are available at a particular facility. If
Grand Rounds Health recommends that you be evaluated
at a specific facility based on your condition, even if the
facility is not a Centers of Excellence facility, the AMP
will assist with the same travel benefits as those paid for
travel to a Centers of Excellence facility. These travel
services must be pre‑approved by Grand Rounds Health and
arranged by HealthSCOPE Benefits. Reimbursement for
medical treatment or services at the facility are paid under
otherwise applicable AMP terms and are not reimbursed
as Centers of Excellence services at the rates listed in the
chart on the previous page.
IF YOU RECEIVE ELIGIBLE TREATMENT OUTSIDE
THE CENTERS OF EXCELLENCE PROGRAM
If you have a medical condition eligible for care under the
Centers of Excellence program and you choose to receive
treatment in a facility outside the Centers of Excellence
program without having received an exception, as described
below, services will be subject to terms summarized in
the Centers of Excellence chart on the previous page. In
some cases, absent an exception, the AMP will not pay any
benefits if eligible services are not provided through the
Centers of Excellence program, even if the services are
provided by a network provider.
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Services you receive prior to arrival or following discharge
from a Centers of Excellence facility, including services
approved or recommended by the Centers of Excellence
program administrator, are subject to regular AMP
coverage terms.
a network provider). Your coinsurance will not count
toward your out‑of‑network deductible or out‑of‑pocket
maximum. The AMP will not pay any benefit if you have the
procedure performed by a nonpreferred network provider
or a non‑network provider, if applicable.
Under limited circumstances, the AMP provides
out‑of‑network coverage for hip or knee replacement
as described below in the Hip or knee replacement and
spine surgery section and summarized in the Centers of
Excellence chart earlier in this section.
HEART SURGERY AND VALVE
REPAIR/REPLACEMENT
Before services to repair or replace a cardiac valve you
may want to consider an eReview by Cleveland Clinic for
non‑emergency cases. Contact your health care advisor
at the phone number on your plan ID card to start the
eReview. If you choose to participate in the Centers of
Excellence program for your heart surgery, your third‑party
administrator will connect you with Contigo Health. If you
utilize a Centers of Excellence facility, covered services
to repair or replace your heart valve are covered at the
Centers of Excellence benefit level, as summarized in
the Centers of Excellence chart earlier in this section.
If you receive the covered services outside the Centers of
Excellence program, your regular AMP benefit terms apply.
HIP OR KNEE REPLACEMENT AND
SPINE SURGERY
Hip or knee replacement: If you are eligible to participate
in the Centers of Excellence program for hip or knee
replacement and you choose to receive treatment in a
facility outside the Centers of Excellence program, services
will generally be considered out‑of‑network, even if the
provider is a provider in your AMP option’s network. In this
case, the AMP’s coverage terms are as follows:
• If you are enrolled in the Premier, Contribution, Saver Plan
options in areas other than central and northeast Florida;
Oklahoma and Texas (select counties) and northwest
Arkansas, you will be required to meet the out‑of‑network
annual deductible before the AMP pays any benefits. After
your out‑of‑network deductible is met, the AMP will pay
50% for covered services provided by network provider
or non‑network provider. Your coinsurance will not count
toward your out‑of‑pocket maximum.
• If you are enrolled in the Premier, Contribution, Saver
Plan options in central and northeast Florida; Oklahoma
and Texas (select counties) and northwest Arkansas, you
will be required to meet the network annual deductible
before the AMP pays any benefits. After your deductible is
met, the AMP will pay 50% for covered services provided
by a preferred network provider (for northwest Arkansas,
the AMP will pay 50% for covered services provided by
• If you have coverage under any of the local plan options
and have your procedure performed by a provider
outside the Centers of Excellence program, no benefits
are payable, unless you are eligible for an exception, as
described below.
Spine surgery: If you are eligible for Centers of Excellence
benefits and you choose to receive treatment in a facility
outside the Centers of Excellence program, your treatment
will be considered out‑of‑network, even if the provider is a
network provider for other purposes. In such circumstances,
no benefits are payable, unless you are eligible for an
exception, as described below.
Physical therapy for spine surgery or joint (hip and knee)
replacement: If you participate in the Centers of Excellence
program for spine surgery or hip or knee replacement, you
may have access to digital physical therapy. This app‑based
approach is designed to help you prior to and after surgical
procedures. Services will be at no cost to you, unless you
are in the Saver Plan. If you are in the Saver Plan, you must
meet your annual network deductible before the AMP
pays any benefit. This service is not available outside of
Centers of Excellence program, including when a network
exception is granted. Contact Contigo Health, the program
administrator, for more details on this program.
Requests for exceptions to coverage terms for spine
surgery and hip and knee replacement
In cases of spine surgery and hip and knee replacement,
you may request an exception to the rules stated
immediately above, which describe how the AMP covers
these procedures when they are performed outside the
Centers of Excellence program. You may request an
exception so that the AMP will pay regular AMP benefits
for covered services from a provider that is not a Centers
of Excellence provider. Depending on whether you have
already received treatment when you make your request, it
will be treated as a pre‑service claim or post‑service claim
(as described below) and decided under special rules for
granting exceptions to the AMP’s coverage terms for spine
surgery and hip and knee replacement under the Centers of
Excellence program, as described below and in the Claims
and appeals chapter.
Pre-service exception request: If you have not yet received
treatment but are considering receiving services from a
non‑Centers of Excellence provider, you may file a prior
authorization request (a pre‑service claim). You can file a
pre‑service claim with Contigo Health if there is significant
risk that travel to the Centers of Excellence provider could
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result in paralysis or death. You can also file a pre‑service claim
if the Centers of Excellence facility does not recommend
spine surgery or hip or knee replacement because it is not
deemed the appropriate medical course of treatment, or you
are not an appropriate candidate for surgery.
Your request should be sent to Contigo Health and will
be considered by an Independent Review Organization
following the procedures described under Special
procedures for approval of exceptions to plan coverage
terms for spine surgery and hip and knee replacement in
the Claims and appeals chapter. If your request is granted,
coverage will be at the otherwise applicable network rate,
including any deductibles, coinsurance, or limitations. If
your request is denied because an Independent Review
Organization determines that travel to a Centers of
Excellence provider is safe or the Centers of Excellence
facility’s determination regarding appropriate course
of treatment is upheld, based on the documentation
received, and you choose to have surgery at a non‑Centers
of Excellence facility, the services will be subject to the
AMP terms described above. You may appeal a denial as
described in the Claims and appeals chapter.
Decisions not to move forward with spine surgery or hip or
knee replacement by the respective Centers of Excellence
providers are not subject to review under this process if the
Centers of Excellence provider decides not to: 1) treat you
based on your refusal to follow the terms and conditions of
the Centers of Excellence Program, 2) determines that the
procedure is not appropriate because you refuse to comply
with medical restrictions or requirements, including weight
loss, smoking cessation, alcohol cessation, social support, or
similar factors.
Post-service exception request: If you already have received
services from a non‑Centers of Excellence provider, you
may file a post‑service exception request (post‑service
claim) as described in the Claims and appeals chapter.
Your request will be considered by an Independent Review
organization and may be approved if:
• Your circumstances called for immediate surgery, without
which you would have likely suffered paralysis or loss of
life, or
• Services were provided by a network provider that began
a course of treatment prior to the effective date of this
provision and there has not been an interruption of the
doctor‑patient relationship.
TRANSPLANTS
To be eligible for transplant, lung volume reduction surgery
(LVRS), or CAR T‑cell treatment benefits under the Centers
of Excellence program, you must be enrolled in the AMP
for at least 12 months. If you are enrolled in the PPO Plan
or an HMO plan option, you are not eligible for transplant
benefits, but if you later become covered under one of the
eligible AMP options, your time enrolled in the PPO Plan
or an HMO plan option will count toward the 12‑month
waiting period. Any time enrolled in critical illness insurance
or accident insurance will not count toward the 12‑month
waiting period.
The 12‑month waiting period does not apply to insertion of
durable ventricular assist devices (VADs) or artificial hearts,
regardless of whether the VAD is related to a transplant.
The 12‑month waiting period applies to you and, separately,
to most of your covered family members (except as
described below)—i.e., you and each covered family member
must meet his or her own 12‑month waiting period. If you
add AMP coverage for a new dependent through birth, or
adoption of the child as of the child’s date of birth, your new
dependent’s 12‑month waiting period will be waived.
If you terminate employment and reenroll in the AMP, or
if you drop coverage and reenroll in the AMP, your prior
time enrolled for coverage will count toward the 12‑month
waiting period.
The 12‑month waiting period is waived for localized
associates and their covered family members. The
12‑month waiting period may also be waived when your
doctor certifies that in the absence of a transplant, death
is imminent within 48 hours. See the Claims and appeals
chapter for information on requesting a waiver.
If your doctor recommends a transplant, call HealthSCOPE
Benefits at 479-621-2830.
Guidelines for covered transplants
• You must undergo a pretransplant evaluation at Mayo
Clinic. In performing this evaluation, Mayo Clinic is not
acting as an agent of the AMP. It is the AMP’s intent that
this evaluation be made pursuant to the doctor/patient
relationship between Mayo Clinic and the participant.
Pre‑approved travel, lodging, and a daily allowance will
be provided for you and an adult caregiver for required
transplant evaluations at Mayo Clinic.
If your claim is approved, coverage will be at the otherwise
applicable network or non‑network rate, depending on your
provider, including any deductibles, coinsurance, or limitations.
If your claim is denied, you may request a post‑service appeal
as described in the Claims and appeals chapter.
• Liver, kidney, heart (including durable ventricular assist
devices [VADs] and total artificial hearts), lung (including
lung volume reduction surgery [LVRS]), pancreas,
simultaneous kidney/pancreas, multiple organ, and bone
marrow/stem cell transplants (including CAR T‑cell
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treatment) must be performed at Mayo Clinic, or no
benefits are paid, except when a formal network exception
request is reviewed and approved in instances where
there is a significant risk that travel to Mayo Clinic could
result in death, or the Independent Review Organization
approves coverage at a different facility where Mayo
Clinic determines that it will not recommend and perform
a transplant because it is not the appropriate medical
course of treatment, or the individual is not an appropriate
candidate (see Requests for organ transplants at facilities
other than Mayo Clinic on this page).
• Claims for eligible transplant services performed at
Mayo Clinic (including pediatric) should be filed with
HealthSCOPE Benefits and are covered at 100% with no
annual deductible. However, if you are enrolled in the Saver
Plan, you must meet your annual deductible before the
Plan will make any payments. Additionally, pre‑approved
trave, lodging, and a daily allowance are provided for you
and an adult caregiver, subject to applicable limits.
• The AMP does not cover transplantation of body parts
(e.g., face, hands, feet, legs, arms, uterus) under any
circumstances. Experimental and/or investigational
transplant‑related services are not covered unless those
services are recommended and performed by Mayo Clinic
or an approved facility.
• Benefits for a covered transplant procedure at Mayo
Clinic, and related expenses, including travel, lodging, and
a daily allowance, end one year post‑transplant or after a
one‑year post‑transplant evaluation is performed.
• Covered services for procedures and devices unrelated
to a transplant, as determined by Mayo Clinic, are not
covered at 100% and are subject to applicable AMP
terms and limitations, including annual deductibles and
coinsurance (network and out‑of‑network). This includes
certain gastric‑sleeve procedures performed at Mayo
Clinic during a liver transplant.
• Non‑transplant covered services performed at Mayo
Clinic are subject to applicable AMP terms and limitations,
including copays, annual deductible, and coinsurance
(network and out‑of‑network).
• Travel for transplant‑related services must be arranged
by a transplant coordinator. For travel arrangements, call
HealthSCOPE Benefits at 479-621-2830.
• Claims for transplants and LVRS that are not performed in
accordance with the guidelines stated in this chapter and
in the Claims and appeals chapter will be denied.
• Coverage is limited to transplantation of human organs.
Requests for organ transplants at facilities other than
Mayo Clinic
• You may file a claim with an Independent Review
Organization to request an organ transplant at a facility
other than Mayo Clinic if:
– There is significant risk that travel to Mayo Clinic could
result in death, or
– Mayo Clinic determines that it will not recommend and
perform a transplant because it is not the appropriate
medical course of treatment or you are not an
appropriate candidate for a transplant.
Your claim must be received by the Plan within 120 calendar
days of the initial denial of the transplant by Mayo Clinic.
Your claim will be decided under the special rules for
transplant claims at a facility other than Mayo Clinic,
as described in the Claims and appeals chapter.
• The Independent Review Organization will review any
relevant medical files that were reviewed or generated by
Mayo Clinic, as well as any additional materials you submit,
and will consider various factors, including alternative
courses of treatment, scientific studies and evidence,
other medical professionals’ opinions, the investigational
or experimental nature of the proposed procedures, and
the potential benefit the transplant would have.
• If the Independent Review Organization determines that
the transplant and related course of treatment meet the
terms above, the Independent Review Organization will
approve an exception to pursue a transplant outside of
Mayo Clinic, under regular AMP terms and benefits.
When providing transplant services at a facility other
than Mayo Clinic under these exceptions, the AMP
does not cover the cost of travel or lodging or provide
a daily allowance.
Transplant denials by Mayo Clinic are not subject to review
under this process if Mayo Clinic decides not to treat you
based on your refusal to follow the terms and conditions of
the Center of Excellence Program or determines that the
transplant is not appropriate because you refuse to comply
with medical restrictions or requirements, including but not
limited to weight loss, smoking cessation, alcohol cessation,
social support, or similar factors. Transplant‑related claims
where treatment has already been rendered are decided
under the regular medical claims and appeals procedures
found in the Claims and appeals chapter.
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Pediatric transplant recipients under age 19
• Pediatric transplant recipients under age 19 (except
for cornea and intestinal transplants) must undergo a
pre‑transplant review and, upon request by Mayo Clinic,
an evaluation by Mayo Clinic.
• Once a Mayo review or visit is complete, if transplant
services are sought at a facility other than Mayo Clinic,
covered services will be subject to regular AMP terms
and benefits.
• Travel, lodging and a daily allowance are provided only
if the transplant is performed at Mayo Clinic.
Transplant donor expenses
• Eligible transplant donor expenses with respect to a
living donor are covered when the recipient is an AMP
participant who is eligible for transplant coverage and the
living donor’s medical plan or insurance provider does not
pay for transplant donor charges or expenses.
• Eligible transplant donor expenses with respect to travel
and lodging benefits must be arranged by a transplant
coordinator. It is your responsibility to provide contact
information for the transplant benefit administrator to the
eligible transplant donor, prior to appointments.
• Covered donor charges are paid at the same benefit level
as the recipient according to transplant guidelines, up to
120 days post‑transplant.
• Cadaver organ acquisition and procurement expenses are
covered only when the expenses are part of the provider’s
contracted rate with the Plan’s third‑party administrator.
WEIGHT LOSS SURGERY BENEFIT
Certain weight loss surgeries are covered under the AMP
Centers of Excellence program, including gastric bypass,
gastric sleeve, and duodenal switch surgeries. These are
subject to specific criteria, including but not limited to:
insurance or accident insurance will not count toward
the 12‑month waiting period. If you terminate coverage
for any reason and reenroll in the AMP, your prior time
enrolled for coverage under the AMP will count toward
the 12‑month waiting period.
• You must be willing to travel to the designated facility at
your own expense (travel reimbursement is not provided).
• You must be at least 18 years of age.
• You must have either a body mass index (BMI) of 40
or greater, or a BMI of 35 or greater and at least one
obesity‑related comorbidity factor (type 2 diabetes,
hypertension, cardiovascular disease, etc.).
• You must agree to comply with all requirements for the
duration of the weight loss surgery treatment.
If you had a previous laparoscopic adjustable gastric band
procedure for weight loss purposes, and now need surgical
removal based on medical complications, you can apply
for the weight loss surgery benefit to be evaluated by a
Centers of Excellence facility to determine if you would
be an appropriate candidate for a conversion to a covered
weight loss surgery, during or in conjunction with the
removal of the gastric band. You will be required to provide
documentation demonstrating that you meet the required
clinical criteria for bariatric surgery prior to the original lap
band procedure.
If you meet the requirements stated above and your
doctor recommends weight loss surgery, call your health
care advisor at the number on your plan ID card to obtain
a request form, which must be completed by you and your
physician. You must send the completed request form
to Contigo Health at the address listed on the form. A
claim is considered filed when Contigo Health receives
the request form. The claim is determined under the
procedures for pre‑service claims described in the Claims
and appeals chapter.
• Services must be provided by a physician and facility
LIMITED COORDINATION OF BENEFITS
designated by the AMP.
• You must be enrolled in the AMP for at least 12 months.
If you are enrolled in the PPO Plan or an HMO plan
option, you are not eligible for weight loss surgery
benefits, but if you later become covered under one of
the other AMP options, your time enrolled in the PPO
Plan or HMO plan option will count toward the 12‑month
waiting period. Any time enrolled in critical illness
The AMP generally does not coordinate benefits with
respect to claims under the Centers of Excellence
program, other than coordination with Medicare in the
case of certain transplant benefits or as otherwise required
by law. For all other Centers of Excellence services, if any
portion of a Centers of Excellence benefit could have been
paid by another health plan, as primary plan, the AMP will
not pay any amount of the claim.
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To find out whether a Walmart Care Clinic or Walmart
Health is a network provider, view your network provider
directory or contact your third‑party administrator.
Helping you manage your health
In addition to the specific covered services discussed in
the prior sections, there are a number of services offered
under the AMP that help you put all of the AMP’s benefits
work for you. The sections beginning on the following page
discuss these programs and services. Note that some
services are located only in certain areas or with certain
plan options, as indicated. If you are enrolled in the fully
insured PPO Plan option, some of these programs are also
available to you.
Walmart Clinics
Walmart Care Clinic and Walmart Health (collectively
“Walmart Clinic(s)”) are primary health care clinics
found in select Walmart stores. They offer retail primary
care services including office visits, lab tests, and some
preventive care services, for individuals age two and older.
Office visits are offered to most covered associates at the
discounted price of a $4 copay, regardless of residency or
work location. However, if you are enrolled in the Saver Plan
option you must pay the posted retail price when using a
Walmart Clinic, until you have met your network deductible,
unless the Walmart Clinic visit is limited to preventive
services. HSA dollars may be used as payment for qualified
medical expenses received at the Walmart Clinics.
Lab tests and immunizations that are not covered as
preventive care under the AMP are available at a separate
charge in addition to the visit charge.
Certain preventive services available at the Walmart Clinic
are covered under all AMP options at no cost to you and
your covered family members. See the Preventive care
program section earlier in this chapter.
NETWORK COVERAGE FOR CERTAIN
WALMART CLINICS
Your third‑party administrator may contract with an
individual Walmart Clinic to be a network provider, but not
all Walmart Clinics are network providers.
If the Walmart Clinic is a network provider under your
medical plan option: The clinic will file claims with the AMP.
The $4 copay for the office visit (or posted retail price if
you are in the Saver Plan and have not met your network
deductible) will not count toward your annual deductible but
will count toward your out‑of‑pocket maximum. Charges for
other services, such as lab tests, will be subject to regular
AMP terms.
If the Walmart Clinic is not a network provider under your
AMP option: The clinic will not file claims with the AMP.
The $4 copay for the office visit (or posted retail price if
you are in the Saver Plan and have not met your network
deductible) and any additional charges for other services,
such as lab tests, are not reimbursable under the AMP and
will not be credited against your annual deductible or out‑
of‑pocket maximum.
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NAVIGATING YOUR BENEFITS
HEALTH CARE ADVISOR
Your health care advisor is your single point of contact for all inquiries. Depending on the nature of your issue, they will answer
your question or direct you to the right place. Just call the number of the health care advisor on your plan ID card.
This service is available to you if the following apply:
• You are in the Premier, Contribution, or Saver Plan option, or local plan or PPO Plan option, and
• Your work location is not in Illinois, Indiana, Missouri, North Carolina, South Carolina, or Virginia.
PERSONAL HEALTHCARE ASSISTANT
Your Personal Healthcare Assistant is your single point of contact for all inquiries. You can find out what’s covered under your AMP
option, find a highly‑rated doctor based on your preferences, get personalized health care recommendations for new or existing
conditions, and find information on care management services. Depending on the nature of your issue, the Personal Healthcare
Assistant will answer your question or direct you to the right place. Just call the number of the Personal Healthcare Assistant on
your plan ID card.
This service is available to you if all of the following apply:
• You are in the Premier, Contribution, or Saver Plan option, and
• UMR is not your third‑party administrator, and
• Your work location is in Illinois, Indiana, Missouri, North Carolina, South Carolina, or Virginia.
GRAND ROUNDS HEALTH: PROVIDER SEARCH AND SECOND OPINIONS
Depending on your work location and AMP option, Grand Rounds Health offers you a variety of services and tools that let you
search for doctors and medical services online, view quality information, obtain expert second opinions, and get additional details
about a provider’s charges. Register at GrandRounds.com/Walmart or by calling Grand Rounds Health at 800-941-1384. You can
also download the Grand Rounds Health app from the App Store or Google Play. There is no cost to you to use the Grand Rounds
Health tool, but any medical expenses you incur as a result of your use of these services and tools will be subject to AMP rules.
Provider search: Participants and dependents age 13 and over who are enrolled in the AMP are eligible to use the Grand Rounds
Health provider search functions:
Grand Rounds Health self-service tool: Grand Rounds Health will match you with highly rated, network physicians and facilities
suited for your clinical needs. You will also be able to view quality information for MD/DO providers.
The self-service tool is available to you if the following applies:
• You are in the Premier, Contribution, or Saver Plan option, or local plan or PPO Plan option.
Grand Rounds Health live support. Call Grand Rounds Health at 800-941-1384 for help finding a highly rated network provider,
scheduling, and preparing for an appointment. You will also be able to get quality information for physicians.
This service is available to you if all of the following apply:
• You are in the Premier, Contribution, or Saver Plan option, or local plan or PPO Plan option, and
• Your work location is not central and northeast Florida, Oklahoma, Texas (select counties), or northwest Arkansas, and
• UMR is not your third‑party administrator.
Expert Second Opinions
Participants and dependents who are enrolled in the AMP are eligible to obtain an expert second opinion with Grand Rounds
Health. Under certain circumstances, when you have received a diagnosis or been recommended for surgery or a certain
treatment, the AMP will cover second opinions provided online through Grand Rounds Health.
This service is available to you if the following applies:
• You are in the Premier, Contribution, or Saver Plan option, or local plan or PPO Plan option.
Claims Advocacy
Grand Rounds Health care team can assist you with the financial aspects of medical claims. Specialized claims experts can answer
your questions regarding medical bills or explanations of benefits, organize insurance paperwork, audit provider and hospital charges,
advocate on your behalf to resolve billing inaccuracies, and negotiate with providers and insurers as needed for claim denials.
This service is available to you if all of the following apply:
• You are in the Premier, Contribution, or Saver Plan option, and
• Your work location is not central and northeast Florida, Oklahoma and Texas (select counties), or northwest Arkansas, and
• UMR is not your third‑party administrator.
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NAVIGATING YOUR BENEFITS
INCLUDED HEALTH
Included Health will provide you with assistance in finding network LGBTQ+ affirming health care providers. You will also receive
advocacy and support services to assist with family, social, and workplace questions pertaining to being LGBTQ+. Enroll by visiting
IncludedHealth.com/member or call 800-941-1384.
This service is available to you if the following applies:
• You are in the Premier, Contribution, or Saver Plan option, or local plan or PPO Plan option.
CARE MANAGEMENT
If you are enrolled in a plan offered by the AMP, you have the benefit of voluntary care management services, including a
personal medical team. Care management brings consistency to the full range of care and services provided under the AMP. Care
management aims to look at the whole individual rather than just the symptoms or conditions being diagnosed; it can result in
higher quality of care, improvement in your experience with your providers, and potentially lower out‑of‑pocket medical expenses.
Circumstances in which a care manager may work with you include the following:
• You are sick or injured and hospitalized
• You are scheduled for surgery
• You find out you have a chronic illness or are dealing with an ongoing chronic illness
• You have a behavioral health/substance use disorder
• You are prescribed multiple prescription drugs with potential interactions
• You simply have a question about your health
• You are home from the hospital and need help understanding your discharge plan, or
• You are participating in the Life with Baby Maternity Program, or comparable maternity program offered by certain local
plan options.
Your care manager, working with your medical team, can approve certain medically necessary services that are not otherwise
covered by the AMP because they exceed a treatment limit (i.e., number of days or visits). The AMP’s rules regarding annual
deductibles and coinsurance continue to apply to any additional benefits authorized by the care management program. The
services must also be medically necessary.
Your medical team may also be able to assist you with medical costs you may incur for “involuntary” out‑of‑network services.
These are costs you incur when you cannot control your choice of provider (such as if you have surgery in a network hospital
but your anesthesia is administered by an anesthesiologist who is a non‑network provider) or when you have a reasonable basis
for believing your provider is a network provider. In some cases, out‑of‑network benefits may be paid as network benefits
(see When network benefits are paid for out-of-network services earlier in this chapter). In other cases, your third‑party
administrator may negotiate with non‑network providers before or after services are rendered to reduce the billed charges
for which you are responsible under the Plan’s out‑of‑network benefit. There are no guarantees that any reduction in your
out‑of‑network costs will occur.
When you communicate with your health care advisor or personal health care assistant, depending on the nature of your inquiry,
you may be routed to your care manager. On other occasions, your care manager may reach out to you, for example to invite you
to participate in a health management program or to assist you in locating certain resources and services in your community.
To reach your care manager, call your health care advisor or personal health care assistant at the phone number on your plan ID
card. Participation in the program is voluntary and does not affect your eligibility to participate in the AMP.
This service is available to you if the following applies:
• You are in the Premier, Contribution, or Saver Plan option, or local plan or PPO Plan option.
VIRTUAL PRIMARY CARE
In addition to using Doctor On Demand for telehealth video visits for urgent care and behavioral health services, you can also
use Doctor On Demand for Virtual Primary Care. You can get help with everyday health needs or serious ongoing health issues
from a Virtual Primary Care doctor who can refer you to clinical specialists when necessary. Visit Doctor On Demand online at
DoctorOnDemand.com/WalmartCare or call 855-377-2200.
This service is available to you if the following apply:
• Your work location is in Alabama, Alaska, Arizona, Colorado, Illinois, Indiana, Iowa, Kentucky, Minnesota, Missouri, North
Carolina, South Carolina, Tennessee, Virginia, West Virginia, or Wisconsin, and
• You are in the Premier, Contribution, or Saver Plan option, or Banner or UnityPoint Local Plan options.
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NAVIGATING YOUR BENEFITS
QUIT TOBACCO PROGRAM
According to the National Institutes of Health, tobacco use is a leading cause of preventable disease and death in the United
States. To help you kick the habit, the AMP offers a free Quit Tobacco program for you and your covered family members age 18
and older.
When you enroll in the program, a variety of services may be available to you, including:
• Online support from coaches and other quitters.
• Phone‑based coaching with a trained health coach.
• Quit Guide handbook, available online or mailed to your home.
• Email support with tips to help you quit and stay motivated.
• Over‑the‑counter (OTC) medications, including free patches, gum, or lozenges. (You may hear these medications referred to as
“nicotine replacement therapy” or “NRT.”)
To enroll in a Quit Tobacco program call 866-577-7169. Learn more about the Quit Tobacco program at
One.Walmart.com/QuitTobacco.
You are eligible for this program if the following applies:
• You are in the Premier, Contribution, or Saver Plan option, or local plan or PPO Plan option.
LIFE WITH BABY MATERNITY PROGRAM
Life with Baby is an exclusive prenatal care program offered at no cost to you, your covered spouse/partner, and other covered
family members. The program is available to you if you are enrolled in the AMP options listed below (with the exception of some
local plans), which provide comparable maternity programs for their participants. (Call your health care advisor or Personal
Healthcare Assistant for more information.)
Whether you’re starting a family, adding to one, or just thinking about it, Life with Baby can help you have a safe, successful
pregnancy. The program is offered at no cost, but enrollment is not automatic. The program assists with preconception,
pregnancy, delivery (including three lactation visits), and child development. Enroll in Life with Baby by calling your health
care advisor at the phone number on your plan ID card. Once enrolled, you’ll have the opportunity to talk confidentially with a
registered nurse before, during, and after your pregnancy, as well as access to a maternity app through Ovia. Participation in the
program is voluntary and does not affect your eligibility to participate in the AMP.
You are eligible for this program if the following applies:
• You are in the Premier, Contribution, or Saver Plan option, or local plan or PPO Plan option.
SPECIALTY MEDICATION REDIRECTION PROGRAM
If you receive infused or injected specialty medications, this optional program supports a transition of services from a hospital
setting to alternative sites of care such as a physician’s office, infusion suite, or your home. Program clinicians evaluate
appropriate infusion sites based on detailed case reviews and provide you with proposed alternative sites of care. For more
information call OptumRx at 844-705-7493 or your health care advisor at the number on your plan ID card.
You are eligible for this program if the following applies:
• You are in the Premier, Contribution, or Saver Plan option, or local plan or PPO Plan option.
DIABETES SELF-CARE
Through myAgileLife, you will have access to lower copays for certain diabetes‑related medications by enrolling for the diabetes
self‑care program. This is a voluntary program where incentives are based on participation in myAgileLife programs, not on
achieving a health status.
The program features a text messaging‑based coaching curriculum designed to help you develop behaviors that support stated
health objectives and outcomes (i.e., medication adherence, diet, exercise, self‑monitoring, and provider engagement/interaction
as part of an effective diabetes self‑management regimen to reduce A1C, improve quality of life, and avoid unnecessary health
care utilization).
To continue in the program, you must comply with the formulary and sourcing requirements specified by the Plan, where
applicable, and remain active in the program in accordance with program terms.
You are eligible for this program if the following applies:
• You are in the Premier, Contribution, or Saver Plan option, or local plan or PPO Plan option.
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BEHAVIORAL/EMOTIONAL HEALTH CARE
You will have the benefit of voluntary care management services through AiRCare, in addition to the other care management
resources described in this section. The goal of all care management resources available to you under the AMP is to bring
consistency to the full range of care and services provided to you by looking at you as a whole individual.
AiRCare is a clinical services company offering a data‑driven, comprehensive clinical approach to the treatment of emotional and
behavioral health conditions. AiRCare reviews Plan data to identify participants in the AMP who could benefit from emotional
and behavioral health support. AiRCare’s licensed clinicians then proactively reach out to those participants to offer support
and counseling, and connect participants with other Plan benefits, including behavioral health services, and, as appropriate,
community resources to augment care.
You are not required to utilize the services of AiRCare or engage with an AiRCare licensed clinician that reaches out directly to
you. This care management resource is voluntary.
You are eligible for this program if the following apply:
• Your work location is in Arkansas, and
• You are in the Premier, Contribution, or Saver Plan option, or local plan option.
PHYSICAL THERAPY THROUGH OMADA FOR JOINT AND MUSCLE HEALTH
You have access to Omada for Joint and Muscle Health, an app‑based approach to physical therapy. Whether you want to prevent
an injury, recover from one, or manage pain, Omada provides personalized care and includes unlimited chat and video visits,
making it easier for you to stick to your care plan. Omada is subject to your deductible and any copays or coinsurance. Download
the app at OmadaHealth.com/Walmart.
You are eligible for this program if the following apply:
• Your work location is in Alabama, Alaska, Arizona, Colorado, Illinois, Indiana, Iowa, Kentucky, Minnesota, Missouri, North
Carolina, South Carolina, Tennessee, Virginia, West Virginia, or Wisconsin, and
• You are in the Premier, Contribution, or Saver Plan option, or a local plan option.
DIGESTIVE HEALTH CARE THROUGH GIThrive
You have access to GIThrive, an app‑based approach to gastrointestinal care. GIThrive offers a digital health program for relief of
digestive conditions and improvement of gut health. The GIThrive program can help provide relief for a wide range of digestive
health symptoms, at no cost to you. GIThrive includes unlimited appointments with a registered dietitian and health coach,
personalized action plans, and proven methods for coping with stress and anxiety affecting your gut health. Download the app at
GIThrive.com/Walmart.
You are eligible for this service if the following apply:
• Your work location is in Alabama, Alaska, Arizona, Colorado, Illinois, Indiana, Iowa, Kentucky, Minnesota, Missouri, North
Carolina, South Carolina, Tennessee, Virginia, West Virginia, or Wisconsin, and
• You are in the Premier, Contribution, or Saver Plan option, or a local plan option.
Preventive care program
For a preventive care service to be eligible for 100%
coverage, it must fall under a recommendation by one of
the agencies responsible for maintaining U.S. preventive
care guidelines, as required under the Affordable Care
Act. Many of these guidelines are specific to gender, age,
or risk factors for a disease or condition. Check with your
third‑party administrator for details. Review charts with
coverage terms in the AMP options available to you section
earlier in this chapter to determine when the AMP pays
the entire cost of preventive services under your option.
Preventive services may not be paid at the 100% benefit
level if you receive services from a nonpreferred network
or non‑network provider, if you are in an AMP option that
has preferred and nonpreferred network providers.
Covered services include those listed below. Refer to your
third‑party administrator for information on preventive
services not listed here. For the most up‑to‑date list of
covered preventive services, go to One.Walmart.com or
call your third‑party administrator at the number on your
plan ID card.
COVERED PREVENTIVE SERVICES FOR ADULTS
• Abdominal aortic aneurysm one‑time screening for men
of specified ages who have ever smoked
• Alcohol misuse screening and counseling
• Aspirin use for men and women of certain ages
(prescription required). See The pharmacy benefit chapter
for more information.
• Blood pressure screening for all adults
• Colorectal cancer screening for adults age 45 and over
• Depression screening for adults
• Diabetes (type 2) screening for adults age 40–70 who
are overweight or obese, and counseling for patients with
abnormal blood glucose
• Diet and physical activity counseling for adults at higher
risk for cardiovascular disease
• Exercise or physical therapy for community‑dwelling
adults age 65 and older who are at increased risk for falls
• Hepatitis B screening for all adults age 18 to 79
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• Hepatitis C screening for adults at high risk
• Breast cancer risk-reducing prescription medications
• HIV screening for all adults at higher risk
• Immunization vaccines for adults — doses, recommended
ages and recommended populations vary:
– Haemophilus influenzae type b
– Hepatitis A
– Hepatitis B
– Herpes zoster
– Human papillomavirus
– Influenza (flu shot)
– Measles, mumps, rubella
– Meningococcal
– Pneumococcal
– Tetanus, diphtheria, pertussis
– Varicella
Learn more about immunizations and see the latest vaccine
schedules at: cdc.gov/vaccines/schedules.
• Latent tuberculosis infection (LTBI) screening in
populations at increased risk
• Lung cancer screening for certain adults age 55–80 who
have a smoking history
• Obesity screening and counseling for all adults
• Preexposure prophylaxis (“PrEP”) with effective
antiretroviral therapy to persons who are at high risk of
HIV acquisition
(such as tamoxifen or raloxifene or aromatase inhibitors)
for certain women at increased risk for breast cancer
• Breastfeeding comprehensive support and three
counseling visits from trained providers, as well as access
to breastfeeding supplies for pregnant and nursing women.
Check with your third‑party administrator for details on
how to obtain a breast pump.
• Cervical cancer screening for women age 21–65
• Chlamydia infection screening for younger women and
other women at higher risk
• Contraception Food and Drug Administration‑approved
contraceptive methods, sterilization procedures
and patient education and counseling, not including
abortifacient drugs. See The pharmacy benefit for
information about contraception.
• Diabetes screening for women with a history of gestational
diabetes who are not currently pregnant and who have not
previously been diagnosed with type 2 diabetes
• Domestic and interpersonal violence screening and
counseling for all women and, when needed, initial
intervention services
• Folic acid supplements for women who may become
pregnant (prescription required). See The pharmacy
benefit for more information.
• Gestational diabetes screening for women 24–28 weeks
pregnant and those at high risk of developing gestational
diabetes
• Sexually transmitted infection (STI) prevention counseling
• Gonorrhea screening for younger women and other
for adults at higher risk
women at increased risk
• Skin cancer counseling for young adults to age 24
• Hepatitis B screening for pregnant women at their first
• Syphilis screening for all adults at higher risk
prenatal visit
• Tobacco use screening for all adults and cessation
• Human immunodeficiency virus (HIV) screening
interventions for tobacco users
and counseling
• Unhealthy drug use screening (i.e., asking questions) for
• Maternal depression screening for mothers at certain
adults age 18 and older
well‑child visits
COVERED PREVENTIVE SERVICES FOR
WOMEN, INCLUDING PREGNANT WOMEN
• Anxiety screening in adolescent and adult women,
including those who are pregnant or postpartum
• Aspirin (low dose) for women 12 weeks pregnant who are
at high risk for preeclampsia (prescription required). See
The pharmacy benefit for more information.
• Bacteriuria urinary tract or other infection screening for
pregnant women
• Osteoporosis screening for women over age 65, and
younger postmenopausal women depending on risk factors
• Perinatal depression counseling interventions or referrals
for pregnant and postpartum women who are at increased
risk of perinatal depression
• Preeclampsia screening for pregnant women, with blood
pressure measurements throughout pregnancy
• Rh incompatibility screening for all pregnant women and
follow‑up testing for women at higher risk
• Sexually transmitted infections (STI) counseling for
• BRCA counseling about genetic testing for women at
sexually active women
higher risk; and, if indicated after counseling, BRCA testing
• Syphilis screening for all pregnant women or other women
• Breast cancer chemoprevention counseling for women at
at increased risk
higher risk
• Breast cancer mammography screenings every 1–2 years
for women over 40
• Tobacco use screening and interventions for all women,
and expanded counseling for pregnant tobacco users
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• Urinary incontinence screening annually, and referral for
further evaluation and treatment if indicated
Learn more about immunizations and see the latest vaccine
schedules at cdc.gov/vaccines/schedules.
• Well-woman visits to obtain recommended preventive
services for women
COVERED PREVENTIVE SERVICES
FOR CHILDREN
• Anemia screening for children at 12 months
• Autism screening for children at 18 and 24 months
• Behavioral assessments for children of all ages
• Bilirubin screening for newborns
• Blood pressure screening for children of all ages
• Blood screening for newborns
• Lead screening for children at risk of exposure
• Medical history for all children throughout development
• Obesity screening and counseling
• Oral health risk assessment for young children, newborn
to 10 years
• Phenylketonuria (PKU) screening for this genetic disorder
in newborns
• Physical examination for children of all ages
• Sexually transmitted infection (STI) prevention counseling
and screening for adolescents at higher risk
• Skin cancer counseling for young adults to age 24 and
• Cervical dysplasia screening for sexually active females
parents of young children
• Congenital hypothyroidism screening for newborns
• Tobacco, alcohol, or drug use assessment for adolescents
• Critical congenital heart defect screening for newborns
at higher risk
• Depression screening for adolescents
• Developmental screening for children under age 3, and
surveillance throughout childhood
• Dyslipidemia screening for children at higher risk of
lipid disorders
• Fluoride chemoprevention supplements for children
without fluoride in their water source and fluoride
varnish to the primary teeth of all infants and children
(prescription required)
• Gonorrhea preventive medication for the eyes of all
newborns
• Hearing screening for all children
• Height, weight, length, head circumference, weight for
length and body mass index measurements for children
• Hemoglobinopathies or sickle cell screening for newborns
• Hepatitis B screening in adolescents at high risk
• HIV screening for adolescents
• Immunization vaccines for children from birth to
age 18 — doses, recommended ages, and recommended
populations vary:
– Diphtheria, tetanus, pertussis (DTaP and Tdap)
– Haemophilus influenzae type b
– Hepatitis A
– Hepatitis B
– Human papillomavirus
– Inactivated poliovirus
– Influenza (flu shot)
– Measles, mumps, rubella
– Meningococcal
– Pneumococcal
– Rotavirus
– Varicella
• Tobacco use interventions in school‑aged children and
adolescents who have not started to use tobacco
• Tuberculin testing for children at higher risk of tuberculosis
• Vision screening for all children.
FLU VACCINE PROGRAM
An annual flu vaccination is a preventive service and covered
according to the terms detailed in this section describing
the Preventive care program. The vaccine may also be
provided in participating Walmart and Sam’s Club pharmacies.
COVID-19 PREVENTIVE SERVICES
(INCLUDING VACCINES)
During the public health emergency declared by the
Secretary of Health and Human Services as a result
of COVID‑19 (the “Public Health Emergency”), the
AMP will cover any “qualifying coronavirus preventive
service” (within the meaning of 29 CFR § 2590.715–2713)
with no cost‑sharing, whether the service is provided
by a network preferred provider, network provider, or
non‑network provider.
As of the date this Associate Benefits Book is
printed, “qualifying coronavirus preventive
service” includes certain COVID‑19 vaccines. See
cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html
for the most up‑to‑date list of COVID‑19 vaccines in this
category. Thus, during the Public Health Emergency, the
AMP will cover these COVID‑19 vaccines with no cost‑
sharing, whether the vaccines are provided by a network
preferred provider, network provider, or non‑network
provider. The AMP will also cover, without cost‑sharing,
the administration of the COVID‑19 vaccines that are
“qualifying coronavirus preventive services.”
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Behavioral health: Mental health and
substance use disorder
Subject to other AMP terms, the AMP includes coverage
for mental health and substance use disorder services in the
same manner as other medical and hospitalization benefits,
including care at a behavioral health facility. A behavioral
health facility is one that:
• Provides 24‑hour inpatient care
• Residential treatment
• Partial hospitalization or outpatient care that requires six
to eight hours of service per day, five to seven days per
week, or
• Intensive outpatient care that requires two to four hours of
service per day, three to five days per week.
What is covered by the AMP
The AMP pays benefits for covered services, which are
charges for procedures, services, equipment, and supplies
that are defined as:
• Not in excess of the maximum allowable charge
• Medically necessary
• Not excluded under the Plan (see What is not covered by
the AMP later in this chapter), and
• Not in excess of AMP limits.
MAXIMUM ALLOWABLE CHARGE
The “maximum allowable charge” (MAC) is the maximum
amount the AMP covers or pays for any health care
services, drugs, medical devices, equipment, supplies, or
benefits covered by the AMP. The MAC applies both to
network and out‑of‑network services.
For covered network services, the MAC is that portion of
a provider’s charge covered by the AMP, as determined by
the provider’s contract with the third‑party administrator. In
the case of BlueAdvantage Administrators of Arkansas, this
includes contracts with an independent licensee company
of the Blue Cross and Blue Shield Association.
From time to time, and notwithstanding any AMP
provisions that state otherwise, the AMP may enter into
an agreement with a non‑network provider (directly or
indirectly through a third‑party administrator) that sets the
rate the AMP will pay for a service or supply. In these cases,
the MAC will be the rate established in the agreement with
the non‑network provider.
For emergency services and certain services provided
by non‑network providers in network facilities, MAC will
be determined under applicable law, which may include
arbitration with a provider. You will not be responsible for
any additional costs, unless your provider follows the notice
and consent process (if applicable) and you give written
consent to be billed by the provider. You are not required to
consent to be billed.
For covered out‑of‑network services, the MAC is
determined by each third‑party administrator, as described
below. In certain circumstances, network benefits may
be paid for out‑of‑network services, as described earlier
in this chapter under When network benefits are paid for
out-of-network services.
Aetna: The MAC is 125% of Medicare’s maximum allowable
charge for voluntary out‑of‑network services. For
involuntary out‑of‑network service, the MAC also is
125% of Medicare’s maximum allowable charge unless the
provider is in Aetna’s National Advantage Program (NAP).
NAP provider charges are paid at a discount. If a Medicare
maximum allowable charge is not published by the Center
for Medicare and Medicaid Services for a specific service,
Aetna uses a gap methodology to calculate the MAC that
is based on the Medicare maximum allowable charge.
Medicare’s allowable rate is based upon the geographic area
in which the service is furnished.
BlueAdvantage Administrators of Arkansas: The method
for establishing the MAC for covered out‑of‑network
services depends on whether the service is delivered
by an individual health care provider (e.g., a physician),
an ambulance or air ambulance service, or a hospital or
facility. For services of individual providers and ambulance
and air ambulance transport, the MAC is 125% of the
Medicare allowed amount for such services on the date
administered. For hospital and facility services or for other
covered benefits (e.g., drugs, medical devices, products
or implants, equipment, or supplies), the MAC for covered
out‑of‑network services is limited to the allowance set by
BlueAdvantage Administrators of Arkansas in its discretion.
If BlueAdvantage Administrators of Arkansas does not have
its own method or benchmark in a given case, the MAC for
covered out‑of‑network services is limited to the pricing or
allowance offered by the Blue Cross and Blue Shield Plan in
the state where services are provided.
For covered out‑of‑network services, the Plan pays the
lesser of MAC or the provider’s actual billed charges. If the
provider’s billed charges exceed the Plan’s MAC, you are
responsible for paying the difference.
HealthSCOPE Benefits: There is no benefit for out‑of‑network
services sought voluntarily by participants in local plans
administered by HealthSCOPE Benefits. For approved
involuntary or emergency out‑of‑network services,
HealthSCOPE Benefits will use a discount through a “wrap
network,” if available and consistent with the Affordable Care
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Act. (A wrap network is a group of non‑contracted providers
who have arranged to provide services to Plan participants
at a discount.) If there is not a discount available through a
wrap network, the MAC will be 125% of Medicare’s maximum
allowable charge. In cases where a Medicare maximum
allowable charge is not published by the Center for Medicare
and Medicaid Services for a specific service, HealthSCOPE
Benefits will use a gap methodology to calculate the MAC.
There may be some cases in which an individual agreement is
reached with the non‑network provider.
UMR: The MAC is 125% of Medicare’s maximum allowable
charge for voluntary and involuntary out‑of‑network
services, unless the out‑of‑network service is involuntary
and the provider is in UMR’s Shared Savings Program
(“SSP”). SSP provider charges are paid at a discount. In
cases where a Medicare maximum allowable charge is
not published by the Center for Medicare and Medicaid
Services for a specific service, UMR uses a gap
methodology to calculate the MAC.
MEDICALLY NECESSARY
”Medically necessary” (or “medical necessity”) generally
means the third‑party administrator (TPA) has determined
the procedure, service, equipment, or supply to be:
• Appropriate for the symptoms, diagnosis, or treatment of
a medical condition
• Provided for the diagnosis or direct care and treatment of
the medical condition
• Within the standards of good medical practice within the
organized medical community
• Not primarily for the convenience of the patient or the
patient’s doctor or other provider, and
• The most appropriate procedure, service, equipment, or
supply that can be safely provided.
”Most appropriate” means:
• There is valid scientific evidence demonstrating that the
expected health benefits from the procedure, service,
equipment, or supply are clinically significant and produce
a greater likelihood of benefit, without disproportionately
greater risk of harm or complications, for the AMP
participant with the particular medical condition being
treated than other possible alternatives
• Generally accepted forms of treatment that are less
invasive have been tried and found ineffective or otherwise
unsuitable, and
• For hospital stays, acute inpatient care is necessary due
to the kind of services the participant is receiving or the
severity of the medical condition, and safe and adequate
care cannot be received as an outpatient or in a less
intensive medical setting.
The TPAs follow their own internal policies in determining
whether a procedure, service, equipment, or supply is
medically necessary. Your AMP benefits are subject to all
terms, conditions, limitations, and exclusions set forth in
the coverage policies administered by your third‑party
administrator regarding medical necessity. Contact your
TPA for more information.
Prenotification
You or your provider may voluntarily contact your third‑
party administrator for information regarding coverage
prior to your obtaining most medical and behavioral health
services by calling the number on your plan ID card. If
you choose to notify your third‑party administrator of a
scheduled medical or behavioral health admission, do so
at least 24 hours prior to the admission. For emergency
services, third‑party administrators should be notified as
soon as possible, but no later than 24 hours after admission.
Providing notification within 24 hours after admission is not,
however, required as a condition of coverage.
The third‑party administrator’s responses to your inquiries
in a prior‑notification call do not guarantee payment or
ensure coverage under the AMP, nor do any statements
made by the third‑party administrator create a contract,
bind the AMP or waive any AMP condition applicable to
your claim for benefits. The third‑party administrator
cannot make a final claim determination on the phone or
by email. This means that any responses given by phone
or email are always subject to further review based on the
particular facts and under the written terms, conditions,
limitations, and exclusions of the AMP.
Preauthorization
Except for specific services listed on the following page,
which require preauthorization under the AMP terms,
non‑network providers are not required to preauthorize
services. However, these services will be covered as
provided for under the AMP and still will be subject to
all applicable AMP terms. Where preauthorization is not
required, it is still recommended that you prenotify your
third‑party administrator, as indicated above.
In addition to specific services listed on the following
page, which require preauthorization under the AMP
terms, network providers may be contractually required
to preauthorize certain other services in order for
these services to be covered under the AMP. Your
network provider will know which services require prior
authorization.
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Where preauthorization is required, these services will be
considered “pre‑service claims” as described in the Claims
and appeals chapter. If a pre‑service claim is denied, you
may appeal, as described in the Claims and appeals chapter.
Network and non‑network providers must preauthorize the
following services under AMP terms, regardless of third‑
party administrator:
NOTE: This is not an exhaustive list. Other
services that must be preauthorized vary based
on TPA. For a complete list of services for
which preauthorization is required, you or your
provider may call your third‑party administrator
at the phone number on your plan ID card.
Review the Resources chart on the first page
of this chapter for information regarding which
entity determines preauthorization requests for
your AMP option.
• Advanced imaging services—MRI and CT scans
• Services provided under the Centers of Excellence
program, including:
– Spine surgery
– Hip and knee replacement
The Plan covers ambulance or air ambulance transportation
where a medical director of a third‑party administrator
recommends transport to a specific facility as medically
necessary based on the individual’s condition and other
contributing factors cited by the treating physician, and
where such transportation is medically necessary compared
to transportation methods of lower cost and safety.
The Plan covers ambulance or air ambulance transportation
between health care facilities if the treatment to be
provided at the second facility is medically necessary and
not available at the initial facility.
The Plan covers ambulance and air ambulance transportation
from a hospital to a hospice facility (including to a residence
where hospice care will be provided).
The Plan covers air ambulance transportation from non‑
network providers of air ambulance services in the same
manner as such services are covered for network air
ambulance providers.
Ambulance charges for the sole convenience of the
participant, caregiver, or provider are not covered.
Birth control/contraceptives: Prescribed FDA‑approved
contraceptive methods for women and female sterilization
are covered under women’s preventive care, including but
not limited to:
– Transplants (including organ, stem cell, bone marrow,
and kidney; CAR T‑cell therapy; ventricular assist
devices [VADs] and total artificial hearts)
• Diaphragms: fitting and supply
• Cervical cap: fitting and supply
– Weight loss surgery
When limited benefits apply
to the AMP
Some services are subject to specific restrictions and
limitations in addition to annual deductible and coinsurance/
copayment requirements. If you have a question on the
coverage of a particular service, contact the third‑party
administrator at the number on your plan ID card.
The limitations and restrictions described below are
in addition to other AMP rules, including deductibles,
coinsurance/copayments, and exclusions. Consideration may
be given for additional coverage when authorized by your
care manager, as described in the Care management section.
Refer also to What is not covered by the AMP, later in this
chapter.
Ambulance: Coverage of ambulance or air ambulance
transportation is limited to the nearest hospital or nearest
treatment facility capable of providing care, and only if such
transportation is medically necessary as compared to other
transportation methods of lower cost and safety.
• Intrauterine device (IUD): fitting, supply, and removal
(including copper or with progestin)
• Birth control pills (including the combined pill, progestin‑
only, and extended/continuous use)
• Birth control patch
• Vaginal ring
• Injection (e.g., Depo‑Provera) given by a physician or nurse
every three months
• Implantable contraception (e.g., Implanon)
• Plan B, when prescribed
• Ella, when prescribed
• Female sterilization (including surgery and surgical
sterilization implant)
• Vaginal sponge, when prescribed
• Female condom, when prescribed
• Spermicide, when prescribed.
The AMP covers generic contraceptives only when
prescribed by a physician (and brand‑name contraceptives
when medically necessary). If your attending physician
believes a brand‑name contraceptive is medically necessary,
you may file a claim for coverage of the brand‑name drug.
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Services and/or devices that are not included in the
contraceptive benefit are:
• Abortion
• Prescription abortifacient medication, including but not
limited to RU‑486
• Over‑the‑counter birth control methods that are
not prescribed, including but not limited to Plan
B, spermicides, condoms, vaginal sponges, basal
thermometers, and ovulation predictor kits.
Clinical trials: Approved clinical trials are covered under
limited circumstances. Routine patient costs associated
with participation in Phases I–IV of approved clinical trials
to treat cancer or other life‑threatening conditions, as
determined by the third‑party administrator and required
by law. These costs are subject to the AMP’s applicable
deductibles and limitations and do not include costs of the
investigational item, device, or service, items provided
for data collection, or services that are inconsistent with
established standards of care.
Doula services: Support for pregnant women enrolled
in an AMP option with work locations in Georgia. The
benefit is limited to $1,000 per pregnancy. Coverage is not
subject to the deductible, and no coinsurance or copay is
required. Amounts paid for doula services do not apply to
the deductible or out‑of‑pocket maximum. The doula must
be certified through the National Black Doula Association
or DONA International. Amounts for doula services are
taxable to you.
Durable medical equipment (DME)/home medical supplies:
DME that satisfies all of the following criteria is covered,
except as stated under DME not covered on this page.
DME is equipment that:
• Can withstand repeated use
To be covered, a doctor must include a diagnosis, the
type of equipment needed, and expected time of usage.
Examples of DME include wheelchairs, hospital‑type beds,
and walkers. If equipment is rented, the total benefit may
not exceed the purchase price at the time rental begins.
Repair of DME is covered when all the following are met:
• The patient owns the equipment
• The required repairs are not caused by the patient’s misuse
or neglect of the equipment
• The expense of repair does not exceed the expense of
purchasing new equipment, and
• The equipment is not covered by warranty.
If patient‑owned DME is being repaired, up to one month’s
rental for that piece of DME is covered. Payment is based
on the type of replacement device provided, but will not
exceed the rental allowance for the equipment under repair.
DME not covered: Motor‑driven scooters, invasive
implantable bone growth stimulators (except in the case of
spinal surgeries), sitz bath, seat lift, rolling chair, vaporizer,
urinal, ultraviolet cabinet, whirlpool bath equipment, bed
pan, portable paraffin bath, heating pad, heat lamp, steam/
hot/cold packs, devices that measure or record blood
pressure (except when provided in conjunction with Virtual
Primary Care through Doctor On Demand), and other
such medical equipment or items determined to be not
medically necessary.
Foot care: For nonsurgical foot care in connection with
treatment for the following conditions, the AMP allows a
total of three provider visits per calendar year:
• Bunions
• Corns or calluses
• Flat, unstable or unbalanced feet
• Is used mainly for a medical purpose rather than for
comfort or convenience
• Metatarsalgia
• Hammertoe
• Generally is not useful in the absence of an illness or injury
• Hallux valgus/claw toes, or
• Is related to a medical condition and prescribed by a
• Plantar fasciitis.
physician
• Is appropriate for use in the home, and
• Is determined to meet medical criteria for coverage to
diagnose or treat an illness or injury, help a malformed
part of the body to work well, help an impaired part of the
body to work within its functional parameters, or keep a
condition from becoming worse.
Coverage is also provided for home medical supplies, such
as ostomy supplies, wound‑care supplies, tracheotomy
supplies, and orthotics. Supplies must be prescribed by a
medical doctor (M.D.) or doctor of osteopathy (D.O.) to be
covered. Surgical stockings are limited to 12 stockings per
calendar year.
Services must be prescribed by a medical doctor (M.D.),
doctor of osteopathy (D.O.), or doctor of podiatric
medicine (D.P.M.).
Open‑cutting surgical care (including removal of nail roots)
and nonsurgical care due to metabolic and peripheral
vascular disease are not subject to the calendar‑year limit.
Orthotic devices for the feet may be covered if prescribed
by a qualified doctor and custom‑molded under the doctor’s
supervision, subject to the calendar‑year limit described
above. Orthopedic shoes prescribed by a doctor are limited
to two shoes per calendar year.
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Gender dysphoria treatment: Medically necessary services
for treatment of gender dysphoria are covered:
• Gender reassignment surgery, including both male to
female surgery and female to male surgery
• Hormone replacement therapy, including laboratory
testing to monitor hormone therapy, and
• Psychotherapy visits.
Gender reassignment surgery is not considered medically
necessary for individuals under the age of 18. Cosmetic
services that are not medically necessary are not covered.
Home nursing care: In‑home private‑duty professional
nursing services are covered if provided by a state‑approved
licensed vocational nurse (L.V.N.), licensed practical nurse
(L.P.N.), or registered nurse (R.N.). Services cannot be
rendered by a relative or by someone in the same household
as the patient. Home nursing care benefits are payable up to
a maximum of 100 visits per calendar year. A visit is defined
as two hours or less.
Hospice care: Hospice care is an integrated program
providing comfort and support services for the terminally
ill. Hospice care is covered if you have an estimated
life expectancy of 12 months or less, as attested by the
physician treating the illness. Hospice care can be provided
on an inpatient or outpatient basis and includes physical,
psychological, social, spiritual, and respite care for the
terminally ill person, and support for immediate family
members, including partners, while the covered person is
receiving hospice care. Benefits are available only when
hospice care is received from a licensed hospice agency,
which can include a hospital.
Inpatient and outpatient hospice care are covered up to
365 days per illness. Participants may continue to receive
treatment and participate in approved clinical trials while
obtaining hospice services. Coverage for additional days
may be available if determined to be medically necessary.
Infertility treatment: Services for the diagnosis and
correction of an underlying condition of infertility are
covered. Refer to What is not covered by the AMP later in
this chapter for a list of non‑covered infertility services.
International business travel medical coverage: The company
provides international business medical insurance through
an insurance policy from GeoBlue. If you participate in the
Saver Plan you are not eligible to make HSA contributions
for any month in which you are traveling on company
business outside the U.S. and are covered under the
GeoBlue policy, which provides health benefit coverage
for associates traveling internationally on business. You are
encouraged to consult with your tax advisor if you have
questions about the amount to reduce your contributions
based on your individual circumstances.
Nutritional counseling: Nutritional counseling for children
is covered if it is medically necessary for a chronic disease
(e.g., PKU, Crohn’s disease, celiac disease, galactosemia,
etc.) in which dietary adjustment has a therapeutic role
when prescribed by a physician and furnished by a provider
(e.g., a registered dietician, licensed nutritionist, or other
qualified licensed health professional) recognized under the
AMP. Benefits are limited to three visits per condition per
year. See the Preventive care program section for additional
benefits related to nutritional and obesity counseling for
adults and children.
Off-label use of cancer chemotherapy injectable drugs:
These drugs are covered when medically necessary,
recommended by one of the following three drug
compendia, and not recommended against by one or more
of the same compendia (appropriate to the date of service):
• American Hospital Formulary Service (AHFS) Drug
Information
• Clinical Pharmacology Online, or
• National Comprehensive Cancer Network (consensus) or
category 1 (the recommendation is based on high‑level
evidence and there is uniform NCCN consensus) or
category 2A (the recommendation is based on lower‑level
evidence and there is uniform NCCN consensus).
If you or your physician are unsure about the Plan’s
coverage for any type of prescription drug, verify coverage
details by calling the third‑party administrator of your
medical plan at the number on your plan ID card. You can
also call OptumRx at 844-705-7493.
Off-label use of non-cancer chemotherapy injectable drugs:
These drugs are covered when medically necessary and
recommended under one of the following drug compendia
(appropriate to the date of service):
• American Hospital Formulary Service (AHFS) Drug
Information, or
• Clinical Pharmacology Online.
The Plan does not cover any drug determined by the FDA
to be contra‑indicated or not advisable. Coverage for
FDA‑approved drugs is subject to the AMP’s applicable
requirements and limitations.
Oral treatment: Charges for care of teeth and gums are
covered when submitted by a doctor or dentist, including
but not limited to:
• Prescriptions
• Emergency department services for mouth pain
• Treatment of fractures/dislocations of the jaw resulting
from an accidental injury
• Accidental injury to natural teeth up to one year from the
date of the accident (does not include injuries resulting
from biting or chewing; those may be covered under the
dental plan)
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• Dental procedures necessitated by either severe disease
(including but not limited to cancer) or traumatic event,
as long as the dental service is medically necessary and
the service is incidental to and an integral part of service
covered under AMP medical benefits. Examples of
services include, but are not limited to, the extraction
of teeth prior to or following chemotherapy or radiation
therapy of the head and neck. Treatment of oral
tissues related to chemotherapy must be supported by
documentation of a direct link between the destroyed
bone or gums and the chemotherapy.
• Non‑dental cutting procedures in the oral cavity
• Medical complications that are the result of a dental
procedure, or
• Expenses for dental services performed in a hospital
setting, including facility and professional charges, for
extensive procedures that prevent an oral surgeon from
providing general anesthesia in an office setting, or for
circumstances that limit the ability of the oral surgeon to
provide services in an office setting. Such circumstances
include, but are not limited to, situations in which the
covered person is:
– A child under age 4
– Between the age of 4 and 12, when either:
• Care in a dental office has been attempted unsuccessfully
and usual methods of behavior modification have not been
successful; or
• Extensive amounts of care are required, exceeding
four appointments.
– An individual with one of the following medical
conditions, requiring hospitalization or general
anesthesia for dental treatment:
• Respiratory illness
• Cardiac conditions
• Bleeding disorders
This benefit is payable to a maximum of 20 visits for
physical therapy and 20 visits for occupational therapy per
calendar year. Additional visits may be covered if deemed
appropriate by the care manager.
Pregnancy benefits: Pregnancy expenses are covered the
same as any other medical condition. See Doula services
earlier in this section for information about doula services in
select pilot locations. (Eligible prenatal services are covered
under the preventive care program.)
Benefits are paid for pregnancy‑related expenses of
dependent children. The newborn is covered only if the
newborn is a covered dependent of the covered associate.
See How to change your elections due to a status change
event in the Eligibility and enrollment chapter for
information on enrolling a newborn for coverage.
Prostate-specific antigen (PSA) tests: Covered only when
conducted as part of a clinical diagnosis.
Prosthetics: Prosthetic devices (such as artificial limbs)
are covered if medically necessary and prescribed by a
physician, subject to the terms and conditions of the AMP.
Replacement prostheses are allowed only with a change
of prescription. A licensed prosthetician must perform
replacements of artificial limbs.
Rehabilitative care: Inpatient and/or day rehabilitation is
covered to a maximum of 120 days per condition for the
following clinical groups if clinical criteria are met:
• Stroke
• Spinal cord injury
• Brain injury
• Congenital deformity
• Neurological disorders
• Amputation
• Severe or advanced osteoarthritis involving two or more
• Severe disability (including but not limited to cerebral
weight‑bearing joints
palsy, autism, developmental disability)
• Other severe disease (including but not limited to cancer
or neurological disorder), or
• Compromised airway.
– An individual of any age whose condition requires
extensive procedures that prevent an oral surgeon from
providing general anesthesia in the office setting.
Outpatient physical/occupational therapy: Charges for
outpatient physical/occupational therapy are covered when
services are:
• Prescribed by a medical doctor (M.D.), doctor of
osteopathy (D.O.), or doctor of podiatric medicine
(D.P.M.), and
• Provided by a licensed physical therapy provider or
licensed occupational therapy provider or by one of the
types of doctors listed above.
• Rheumatoid, other arthritis
• Systemic vasculitis with joint inflammation
• Major multiple trauma, or
• Burns.
Specialty care: Medical care commonly provided at the
following types of facilities is covered if you are admitted
to this level of care subsequent to an eligible acute care
hospital confinement:
• Extended care facility
• Long‑term acute care specialty facility
• Subacute care facility
• Skilled nursing facility, or
• Transitional care facility.
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Benefits are limited to a maximum of 60 calendar days per
disability period. Successive periods of confinement due
to the same or related causes are considered one disability
period unless separated by a complete recovery.
If you have a question regarding whether a service is
covered under the Plan, call the third‑party administrator
at the number on your plan ID card or see the inside back
cover of this book for contact information.
Speech therapy: Therapy of up to 60 visits per calendar year
is covered when:
• Prescribed by a medical doctor (M.D.) or doctor of
osteopathy (D.O.), and
• Provided by a licensed speech therapist.
Initial and ongoing plans of treatment and progress reports
may be requested from the prescribing doctor. To be
covered, speech therapy must be for a residual speech
impairment resulting from:
• A cerebral vascular accident
• Head or neck injury
• Partial or complete paralysis of voice cords or larynx
• Head or neck surgery, or
• Congenital and severe developmental speech disorders.
Telehealth visits: Except for Doctor On Demand, which is
paid at 100% for most AMP plan options, other telehealth
visits with your provider are covered subject to the same
terms as in‑person visits, including cost sharing and coverage
based on network or non‑network status of the provider.
Vision services: Diagnosis and treatment of injury or
disease of the eye, including but not limited to diabetic
retinopathy, glaucoma, and macular degeneration, are
covered. Charges for routine eye care, including but not
limited to vision analysis, eye examinations, or eye surgeries
for nearsightedness or correction of vision, are not covered,
except for vision screening for children covered under
preventive care guidelines.
Weight loss treatment: Weight loss surgery is covered only
under the Centers of Excellence program when you meet
specific eligibility guidelines and clinical criteria. Weight
loss treatments, including but not limited to medications,
diet supplements, and surgeries outside the scope of the
Centers of Excellence program, are not covered. See
the Centers of Excellence section of this chapter for
information about weight loss surgery.
What is not covered by the AMP
In addition to the exclusions and limitations listed in the
When limited benefits apply to the AMP section of this
chapter, the following list represents services not covered by
the AMP. Network discounts do not apply to these services.
If you are enrolled in the Saver Plan, you may be able to
use your HSA funds for these and other qualified medical
expenses. For information, contact your HSA administrator.
Acupuncture
Administrative services and interest fees: Charges for the
completion of claim forms, missed appointments, additional
charges for weekend or holiday appointments, interest fees,
collection fees, or attorney fees.
Alternative/nontraditional treatment (including homeopathy,
naturopathy, hypnosis, and massage therapy).
Autopsy
Beyond the scope of licensure or unlicensed: Services
rendered by a non‑credited or a non‑licensed physician,
health care worker or institution, or services rendered
beyond the scope of such person or entity’s license.
Biofeedback
Breast reconstruction/reduction: Any expenses or charges
resulting from breast enlargement (augmentation),
including implant insertion and implant removal, whether
male or female, are not covered except when the implant
is removed as the result of implant damage or rupture.
Replacement of a damaged or ruptured implant is not
covered unless the original implant was placed for
conditions eligible to be paid by the Plan.
Any expenses or charges resulting from breast reductions,
implantations or total breast removal, whether male
or female, are not covered, unless directly related to
treatment of a mastectomy, as provided by law (see The
Women’s Health and Cancer Rights Act of 1998 later in this
chapter), or unless an AMP medical review determines the
procedure is medically necessary.
Chiropractic care: Spinal manipulation, joint manipulation,
or soft‑tissue manipulation, regardless of the type of
provider performing the service, except for limited
coverage for network services provided to participants
enrolled in the Mercy Arkansas Local Plan.
Copays and/or discounts, deductibles and/or coinsurance
Cosmetic health services or reconstructive surgery: Except
for congenital abnormality, services covered by law (see The
Women’s Health and Cancer Rights Act of 1998 later in this
chapter), or conditions resulting from accidental injuries,
tumors or diseases.
Custodial or respite care: Care or services provided in
a facility or home to maintain a person’s present state
of health, which cannot reasonably be expected to
significantly improve.
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Drugs, items and equipment not FDA-approved
Educational services: Including any services for learning and
educational disorders (which include but are not limited to
reading disorders, alexia, developmental dyslexia, dyscalculia,
spelling disorders, and other learning difficulties).
Elective inpatient and outpatient stays or services outside
the U.S.
Expenses related to missed appointments, review or
storage of your health care information or data
Experimental, investigational, and/or treatments and
services that are not medically necessary: Experimental
and/or investigational medical services are those defined as
experimental and/or investigational according to protocols
established by your third‑party administrator. For Centers
of Excellence services, the Centers of Excellence
third‑party administrator makes this determination.
Extracorporeal shock wave therapy: For plantar fasciitis and
other musculoskeletal conditions.
Government compensation: Charges that are compensated
for or furnished by local, state, or federal government, or
any agency thereof, unless payment is legally required.
Hearing devices: Charges for routine hearing tests and
hearing aids, except for hearing screening for children,
covered under preventive care guidelines.
HMO copays
Illegal occupation, assault, felony, riot, or insurrection:
Charges for medical services, supplies, or treatments
that result from or occur while being engaged in an illegal
occupation, commission of an assault, felony, or criminal
offense (except for a moving violation), or participation in a
riot or insurrection.
Infertility services: Treatment by artificial means for the
purpose of creating a pregnancy. Assistive reproductive
technology (ART) and other non‑covered services include
but are not limited to:
• Infertility prescription drugs
• Charges to reverse a sterilization procedure
• Charges for, or related to, the services of a surrogate
mother, egg donor, or sperm donor, and
• In‑vitro fertilization, GIFT, ZIFT, IVC, gamete intra‑
cryopreservation, frozen embryo transfer, and artificial
insemination, including all related charges.
Judgments/settlements
Late claims: Charges received more than 18 months past the
date of service. See Filing a medical claim later in this chapter
for information about coordination of benefits. In the event a
participant establishes that a claim was filed within the stated
time period, but the claim was mistakenly filed with the
company or any third‑party administrator of the Plan, that
time shall not count toward the filing period above.
Marital, family, or relationship counseling: Or counseling
to assist in achieving more effective intra‑ or interpersonal
development.
Military-related injury or illness: Including injury or
illness related to, or resulting from, acts of war, declared
or undeclared.
Neurofeedback
Nonaccredited/nonlicensed providers or institutions
Non-covered services:
• Services not specifically included as a benefit in this
Associate Benefits Book
• Services provided after exceeding the benefit maximum
for specified services
• Services for which you are responsible for payment, such
as non‑covered out‑of‑network charges
• Charges for services above the contracted rates to
providers, or
• Charges for medical records.
Out-of-pocket expenses
Over-the-counter medications and equipment: Except for
specific preventive care medications. See The pharmacy
benefit chapter for more information.
Personal care items: Primarily for personal comfort or
convenience, including but not limited to diapers, bathtub
grabbers, handrails, lift chairs, over‑bed tables, bedboards,
incontinence pads, ramps, snug seats, recreational items,
home improvements and home appliances, spas, wigs, and
knee braces for sports.
Services provided by a member of the patient’s
immediate family
Services provided by a government entity while
incarcerated
Sexual dysfunction services and pharmaceuticals: Including
therapy, treatment, or pharmaceuticals for the treatment of
sexual dysfunction, except for sexual dysfunction resulting
from an accidental injury or treatment for an illness or
condition (e.g., erectile dysfunction resulting from a
prostatectomy or spinal cord injury).
Sports/school physicals: Charges for physical examinations
performed for the purpose of clearing an individual for
participation in a sport or school activity.
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Surrogate parenting: Fees related to surrogacy (other than
maternity care costs for an enrollee otherwise covered
under the plan), whether paying for another’s services or
serving as a surrogate.
Talking aids: Assistive talking devices, including special
computers or devices designed to assist in therapy
treatment to enhance motor and/or psychological abilities.
Termination of pregnancy: Charges for procedures,
services, drugs, and supplies related to abortions or
termination of pregnancy are not covered, except when the
health of the mother would be in danger if the fetus were
carried to term, the fetus could not survive the birthing
process, or death would be imminent after birth.
Travel and lodging, except as specified under Centers of
Excellence benefits
Vitamins: Charges for nonprescription vitamins (whether
oral or injectable), minerals, nutritional supplements, or
dietary supplements, except as outlined in the Preventive
care program section of this chapter.
Walmart Care Clinic/Walmart Health: Charges for
nonpreventive services, except where the Walmart Care
Clinic or Walmart Health is considered a network provider.
Work hardening or similar vocational programs
Workers’ compensation: Treatment of any compensable
injury, as defined by applicable workers’ compensation law,
regardless of whether or not you file a timely claim for
workers’ compensation benefits.
Filing a medical claim
If you use a network provider, the provider will generally file
the claim for you. If you see a non‑network provider, you
may need to file a claim yourself. Claim forms are located on
One.Walmart.com/Medical. You must file within 18 months
from date of service.
If you need to file a claim, it should include the following
information:
• Patient’s name
• Provider’s name, address, and tax identification number
• Associate’s insurance ID (see your plan ID card)
• Date of service
• Amount of charges
• Medical procedure codes (these should be found on the
bill), and
• Diagnosis.
See your plan ID card for the correct address to mail your
claim. Failure to mail your claim to the correct address may
result in the denial of your claim. Claims are determined
under the time frames and requirements outlined in the
Claims and appeals chapter.
When you incur medical expenses and file a claim, or a
claim is filed on your behalf, benefits are paid directly to
the provider for network services. Payment to the provider
discharges the AMP’s obligation to you for the benefit.
If your plan provides coverage for non‑network providers
and you use a non‑network provider, payment may be made
directly to you upon your showing proof of payment in full
to the provider. You are responsible for your cost sharing,
plus any amount above the maximum allowable charge. As
a convenience to you, payment may also be made to a non‑
network provider if you expressly authorize such payment.
Your provider, whether network or non‑network, may not
pursue appeals on your behalf unless you designate your
provider as your authorized representative, as described
in the Claims and appeals chapter. The AMP prohibits the
assignment of any benefit or any legal right, claim, or cause
of action (whether known or unknown).
You have the right to appeal a claim denial, as described in
the Claims and appeals chapter.
If you have coverage under more
than one medical plan
The AMP has the right to coordinate with other plans under
which you are covered so the total medical benefits payable
do not exceed the level of benefits otherwise payable under
the AMP. “Other plans” refers to the following types of
medical coverage:
• Coverage under a governmental program provided or
required by statute, including no‑fault coverage to the
extent required in policies or contracts by a motor vehicle
insurance statute or similar legislation
• Group insurance or other coverage for a group of
individuals, including coverage under another employer
plan or student coverage obtained through an
educational institution
• Any coverage under labor‑management trusteed plans,
union welfare plans, employer organization plans or
employee benefit organization plans
• Any coverage under governmental plans, such as
Medicare or TRICARE, but not including a state plan
under Medicaid or any governmental plan when, by law, its
benefits are secondary to those of any private insurance,
nongovernmental program, and
• Any private or association policy or plan of medical
expense reimbursement that is group or individual rated.
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When you are covered by more than one plan, one of the
plans is designated the primary plan. The primary plan
pays first and ignores benefits payable under other plans
when determining benefits. Any other plan is designated
as a secondary plan that pays benefits after the primary
plan. A secondary plan reduces its benefits by the amount
of benefits payable under “other plans” and may limit the
benefits it pays.
You must follow the primary plan’s terms in order for the
AMP to pay as secondary payer. These rules apply whether
or not a claim is made under the other plan. If a claim is not
made under the other plan and the other plan is the primary
plan, benefits under the AMP will be delayed or denied until
an explanation of benefits is received showing a claim was
made with the primary plan.
The AMP does not coordinate as a secondary payer for any
copays you pay with respect to another plan or with respect
to prescription drug claims or transplants (except where the
other plan is Medicare).
If you reside in a state where automobile no‑fault coverage,
personal injury protection coverage, or medical payment
coverage is mandatory, that coverage is primary and the
AMP is secondary. The AMP reduces benefits for an amount
equal to the state’s mandatory minimum requirement.
Other rules:
• The AMP has first priority with respect to its right to
reduction, reimbursement, and subrogation.
• The AMP does not coordinate benefits with an HMO or
similar managed care plan where you pay only a copayment
or fixed dollar amount.
• The AMP does not coordinate with any other plan other
than Medicare with respect to a covered transplant.
HOW THE AMP COORDINATES WITH OTHER PLANS
Example 1
Example 2
Example 3
If another plan
pays primary at:
And the AMP’s
payment is:
The AMP’s total
benefit is:
80%
75%
0%
80%
100%
20%
0%
75%
75%
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DETERMINING WHICH PLAN IS PRIMARY
A plan without a coordinating provision is always primary.
The AMP has a coordinating provision. If all plans have a
coordinating provision, the following provisions apply:
• The AMP always is the secondary payer to any motor
vehicle policy available to you, including personal
injury protection or no‑fault coverage. If the AMP pays
benefits as a result of injuries or illnesses you sustain and
another party (e.g., an insurance company) bears primary
responsibility for your covered medical expenses, the AMP
has a legal right to reimbursement of benefits. See the
Claims and appeals chapter for more information.
• The plan covering the participant for whom the claim is
made, other than as a dependent, pays first and the other
plan pays second.
• If the plan participant is covered under a retiree medical
plan that includes a coordination of benefits provision, that
provision governs.
• For dependent children’s claims, the plan of the parent
whose birthday occurs earlier in the calendar year is primary.
• When the birthdays of both parents are on the same day,
the plan that has covered the dependent for the longer
period of time is primary.
• When the parents of a dependent child are divorced
or separated, or the domestic partnership or legal
relationship is terminated, and the parent with custody has
not remarried, that parent’s plan is primary.
• When the parent with custody has remarried, or entered
into a domestic partnership with another individual, that
parent’s plan is primary, the stepparent’s plan pays second
and the plan of the parent without custody pays last.
• When there is a court decree that establishes financial
responsibility for the health care expenses of the
child, the plan that covers the parent with financial
responsibility is primary.
• If these rules do not establish an order of benefit
determination, the plan that has covered the participant
for whom the claim is made for the longest period of
time is primary.
• If you are covered under a right of continuation coverage
pursuant to federal or state law (for example, COBRA)
and you are also covered under another plan that covers
you as an employee, member subscriber, or retiree (or as
that person’s dependent), the latter plan is primary and the
continuation coverage is secondary. If the other plan does
not have this rule, and the plans do not agree on the order
of benefits, this rule does not apply.
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IF YOU OR A DEPENDENT IS COVERED
UNDER MEDICAID
IF YOU ARE AGE 65 OR OLDER AND AN
ACTIVE ASSOCIATE
If you or your dependent is a participant in the AMP and also
covered under Medicaid, the AMP pays before Medicaid.
The AMP does not take the Medicaid coverage into account
for purposes of enrollment or payment of benefits.
If you are still working for the company, you may continue
your coverage under the AMP. If you also have Medicare,
the AMP is generally primary and Medicare is secondary.
File your claim with the AMP first.
If, while you are covered under Medicaid, benefits are
required to be paid by the AMP, but are first paid by the
state plan, payment by the AMP will be made as required by
any applicable state law which provides that payment will be
made to the state.
You may also elect to end your coverage under the AMP and
choose Medicare as your primary coverage. If you choose
Medicare as your primary coverage, you may not elect the
AMP as your secondary plan.
IF YOU OR A DEPENDENT IS ELIGIBLE FOR
OR ENROLLED IN MEDICARE
If you are enrolled in Medicare Part D, you are not eligible to
enroll in the AMP. If your dependent is enrolled in Medicare
Part D and you are not, you are eligible to enroll in the AMP,
but your dependent would not be eligible for such coverage.
In general, the Social Security Act requires that AMP be
the primary payer if you or your dependent is eligible for or
enrolled in Medicare Part A, or Parts A and B, and meet one
of the following criteria:
• You are employed by the company and are age 65 or older
• You are employed by the company and your spouse/
partner is age 65 or older
• You are an active participant or COBRA participant
entitled to Medicare on the basis of end‑stage renal
disease, but only for the first 30‑month period of eligibility
for Medicare coverage (whether or not actually enrolled in
Medicare throughout this period)
• You are under age 65 and are entitled to Medicare due to
disability and are covered under the AMP due to being
employed by the company, or
• Your dependent is under age 65 and is entitled to Medicare
due to his or her disability and is covered under the AMP
due to your being employed by the company.
The AMP is secondary if you or your dependent is enrolled
in Medicare and meets one of the following criteria:
• You or your dependent is a COBRA participant, except
in the case of Medicare enrollment due to end‑stage
renal disease, for which the AMP is primary for the first
30‑month period of eligibility for Medicare coverage, or
• You or your dependent is an active participant or COBRA
participant enrolled in Medicare due to end‑stage renal
disease, after the 30‑month coordination period with
Medicare is exhausted.
LEGALLY MANDATED AUTOMOBILE PERSONAL
INJURY OR MEDICAL PAYMENT COVERAGE
If you reside in a state where automobile no‑fault coverage,
personal injury protection coverage, or medical payment
coverage is mandatory, that coverage is primary and the
AMP is secondary. The AMP reduces benefits for an amount
equal to, but not less than, the state’s mandatory minimum
requirement.
Break in coverage
There may be occasions in which you must make special
arrangements to pay your medical premiums to avoid a
break in coverage. These situations occur most commonly
if you are on a leave of absence or if your paycheck is not
sufficient to pay your full share of the cost of coverage
(such as after a reduction in hours). Failure to make your
premium payments by the due date may result in an
interruption in the payment of any benefit claims and/or a
break in coverage.
For details on the impact a break in coverage may have,
and on how to make personal payments to continue your
coverage, see When special arrangements are necessary to
maintain coverage in the Eligibility and enrollment chapter.
IF YOU GO ON A LEAVE OF ABSENCE
You may continue your coverage up to the last day of an
approved leave of absence, provided that you pay your
premiums before or during the leave. For information about
making payments while on a leave of absence, see When
special arrangements are necessary to maintain coverage in
the Eligibility and enrollment chapter.
When coverage ends
Your coverage ends on your last day of employment,
or when you are no longer eligible under AMP terms.
Dependent coverage ends when your coverage ends or
when a dependent is no longer an eligible dependent (as
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defined in the Eligibility and enrollment chapter). You
and/or your enrolled family members may be eligible for
continued coverage through the Consolidated Omnibus
Reconciliation Act of 1985, as amended (COBRA). See the
COBRA chapter for details.
If your coverage is cancelled due to your failure to pay
required premiums, coverage ends on last day for which
premiums were paid. See Paying for your benefits in the
Eligibility and enrollment chapter for information. There
is no right to continue coverage under COBRA when
coverage is cancelled due to nonpayment of required
contributions.
If you voluntarily drop coverage after a status change event
or at Annual Enrollment, coverage ends as follows:
• After a status change event: coverage ends on the
effective date of the event. See Status change events in
the Eligibility and enrollment chapter for information.
• At Annual Enrollment: coverage ends on December 31 of
the current year.
If you leave the company and
are rehired
If you terminate employment and return to work for
the company within 13 weeks, you will automatically be
reenrolled in your previous coverage (or the most similar
coverage offered under the AMP). If you return within 30
days, your annual deductible, out‑of‑pocket maximum and
HRA (if applicable) will not reset. If you return after 30 days
but within 13 weeks, your annual deductible, out‑of‑pocket
maximum and HRA (if applicable) will reset and you will be
responsible for meeting the new deductible and out‑of‑
pocket maximum in their entirety. You will have 60 days
after resuming employment to drop or otherwise change
the coverage in which you were automatically reenrolled.
If you return after 13 weeks, you will be treated as a new
associate and may enroll for coverage under the time
periods and conditions described in the Eligibility and
enrollment chapter.
If you drop coverage and reenroll
If you drop coverage and reenroll within 30 days, you will
automatically be reenrolled in your previous coverage (or
the most similar plans offered under the AMP). The annual
deductible and waiting periods will not reset.
If you drop coverage and reenroll after 30 days, you will
be treated as a new associate and may enroll for coverage
under the time periods and conditions described in the
Eligibility and enrollment chapter.
IF A DEPENDENT IS DROPPED FROM
COVERAGE AND REENROLLED
If your dependent child is dropped from coverage and then
determined to be eligible for coverage within 30 days, the
dependent will automatically be reenrolled in the same
coverage you elect for yourself. The annual deductible and
waiting periods will not reset.
If your dependent regains eligibility and is reenrolled after
30 days, they will be treated as a newly eligible dependent.
The associate may enroll them for coverage under the
time periods and conditions described in the Eligibility and
enrollment chapter.
Other information about
the medical plan
THE WOMEN’S HEALTH AND CANCER RIGHTS
ACT OF 1998
The Women’s Health and Cancer Rights Act of 1998 requires
that all group medical plans that provide medical and
surgical benefits with respect to mastectomy must provide
coverage for:
• All stages of reconstruction of the breast on which the
mastectomy has been performed
• Surgery and reconstruction of the other breast to produce
a symmetrical appearance, and
• Prostheses and physical complications of mastectomy,
including lymphedemas, in a manner determined in
consultation with the attending physician and the patient.
Such coverage will be subject to the otherwise applicable
annual deductibles and coinsurance/copayment provisions
under the Plan. Written notice of the availability of
such coverage shall be delivered to the participant
upon enrollment and annually thereafter. For additional
information, call People Services at 800-421-1362.
A NOTE ABOUT MATERNITY ADMISSIONS
Group health plans and health insurance issuers generally
may not, under federal law, restrict benefits for any hospital
length of stay in connection with childbirth for the mother
or newborn child to less than 48 hours following a vaginal
delivery or less than 96 hours following a cesarean section.
However, federal law does not prohibit the mother’s or
newborn’s attending provider, after consulting with the
mother, from discharging the mother or her newborn earlier
than 48 hours (or 96 hours, as applicable). In any case,
plans and issuers may not, under federal law, require that a
provider obtain authorization from the plan or the insurance
issuer for prescribing a length of stay not in excess of 48
hours (or 96 hours, as applicable).
The pharmacy benefit
The pharmacy benefit
What is not covered by the pharmacy benefit
Pharmacy discounts for prescriptions not covered
Manufacturer assistance and other discounts or coupons
Filing a pharmacy benefit claim
Privacy and security
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The pharmacy benefit
Keep you and your eligible dependents in good health with your pharmacy benefit. It’s automatically
included with your medical plan.
RESOURCES
Find What You Need
Online
Other Resources
Find a Walmart or Sam’s Club pharmacy
Go to One.Walmart.com or
OptumRx.com/Walmart
Find an OptumRx network pharmacy
Go to OptumRx.com
Call OptumRx at 844-705-7493
Get information about Walmart Home
Delivery Pharmacy
Go to One.Walmart.com
Call Walmart Home Delivery Pharmacy
at 866-855-0740
Get information about OptumRx Mail‑Order
Pharmacy
Get the list of covered brand‑name drugs
Go to OptumRx.com
Call OptumRx at 844-705-7493
Go to One.Walmart.com or
OptumRx.com/Walmart
Call OptumRx at 844-705-7493
What you need to know about the pharmacy benefit
• You are automatically covered under the pharmacy benefit if you are enrolled in the Premier, Contribution, or Saver Plan
option or one of the local plan options available under the Associates’ Medical Plan (AMP). If you are enrolled in an HMO
plan or the PPO Plan, your pharmacy benefits are provided through the HMO or PPO, respectively.
• The pharmacy benefit covers only prescription drugs specifically listed on the pharmacy benefit’s formulary.
• The pharmacies discussed in this chapter include:
– Walmart or Sam’s Club pharmacy — including an in‑store or in‑club pharmacy.
– OptumRx network pharmacy — including a Walmart or Sam’s Club pharmacy and any pharmacy in the OptumRx network.
– Walmart Home Delivery Pharmacy and OptumRx Mail‑Order Pharmacy — mail order pharmacies for Walmart and
OptumRx, respectively.
– Walmart Specialty Pharmacy and Optum Specialty Pharmacy — specialty pharmacies for Walmart and OptumRx,
respectively.
• If you are enrolled in the Premier, Contribution, or Saver Plan option:
– If your work location is five miles or less from a Walmart or Sam’s Club pharmacy, you must use any Walmart or Sam’s Club
pharmacy, Walmart Home Delivery Pharmacy, or OptumRx Mail‑Order Pharmacy for generic and brand‑name drugs.
For exceptions, see Pharmacy Options later in this chapter.
– If your work location is more than five miles from a Walmart or Sam’s Club pharmacy, you may use any OptumRx network
pharmacy (including any Walmart or Sam’s Club pharmacy), Walmart Home Delivery Pharmacy or OptumRx Mail‑Order
Pharmacy for generic and brand‑name drugs.
– Specialty drugs must be filled through Walmart Specialty Pharmacy or Optum Specialty Pharmacy.
• If you are enrolled in a local plan option:
– You must use any Walmart or Sam’s Club pharmacy, Walmart Home Delivery Pharmacy, or OptumRx Mail‑Order
Pharmacy for generic and brand‑name drugs, regardless of your work location.
– Specialty drugs must be filled through Walmart Specialty Pharmacy or Optum Specialty Pharmacy.
• If you have a chronic condition such as diabetes, asthma, or arthritis and require the same or similar prescriptions on a
regular basis (maintenance medications), you may want to consider the mail‑order option, which may allow you to obtain
a larger supply with each fill.
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The pharmacy benefit
The pharmacy benefit covers eligible prescription drugs
purchased from certain retail and mail‑order network
pharmacies. No pharmacy benefits are paid if you use a
non‑network pharmacy. The specific retail and mail‑order
network pharmacies that you are required to use depend
on the AMP option in which you are enrolled for medical
coverage and, in some cases, whether your work location
is within five miles of a Walmart or Sam’s Club pharmacy.
You must enroll in medical coverage under the AMP to
obtain coverage under the pharmacy benefit. If you enroll
in medical coverage, your prescription drug coverage is
effective on the date your medical coverage under the AMP
is effective and ends on the date your medical coverage ends.
PHARMACY OPTIONS
If you are enrolled in the Premier, Contribution, or Saver
Plan option and your work location is five miles or less
from a Walmart or Sam’s Club pharmacy, you must use any
Walmart or Sam’s Club pharmacy, Walmart Home Delivery
Pharmacy or OptumRx Mail‑Order Pharmacy for generic
and brand‑name drugs. See exceptions below.
If you are enrolled in the Premier, Contribution, or Saver Plan
option and your work location is more than five miles from a
Walmart or Sam’s Club pharmacy, you may use any OptumRx
network pharmacy (including any Walmart or Sam’s Club
pharmacy), Walmart Home Delivery Pharmacy or OptumRx
Mail‑Order Pharmacy for generic and brand‑name drugs.
If you are enrolled in a local plan option, you must use any
Walmart or Sam’s Club pharmacy, Walmart Home Delivery
Pharmacy or OptumRx Mail‑Order Pharmacy for generic
and brand‑name drugs, regardless of your work location.
See exceptions below.
Specialty drugs must be filled through Walmart Specialty
Pharmacy or Optum Specialty Pharmacy regardless of
which AMP option you are enrolled in.
Under limited circumstances you may fill prescriptions at an
OptumRx network pharmacy even if your work location is
within five miles of a Walmart or Sam’s Club Pharmacy and
regardless of the AMP option you are enrolled in, including:
• If the AMP determines that a covered drug is out of stock
and not available at a Walmart or Sam’s Club pharmacy for
an extended time.
• If the AMP determines that a covered drug is unavailable at
a Walmart or Sam’s Club pharmacy
• If an emergency prescription fill is needed outside Walmart
or Sam’s Club pharmacy hours.
For information , call OptumRx at 844-705-7493.
NOTE: Certain restrictions apply to filling prescriptions for
narcotics and other controlled substances.
COVERED PRESCRIPTION DRUGS
The pharmacy benefit covers only prescription drugs
specifically listed on the pharmacy benefit’s formulary,
which is a list of generic and brand‑name medications
that have been tested for quality and effectiveness and
are believed to be a necessary part of a quality treatment
program. The formulary is maintained by OptumRx. You can
view an abbreviated list on One.Walmart.com or you can
call OptumRx at 844-705-7493 for a full list. If you don’t
see your drug on the list, call OptumRx to see if it is on the
formulary. The formulary is subject to change without prior
notice at any time during the calendar year.
The pharmacy benefit has a closed formulary. This means
that your prescription drugs, whether they fall under the
generic, brand‑name, or specialty drug category, must be
included on the formulary for pharmacy benefits to be paid.
YOUR COST SHARING FOR COVERED
PRESCRIPTION DRUGS
See the Pharmacy benefits chart on the next page for
details about copays and coinsurance.
If you are in the Premier Plan, Contribution Plan, or a local
plan option, you are required to pay the copay or coinsurance
out of your own pocket when you purchase your prescription
drugs. (If you are covered under the Contribution Plan,
HRA funds cannot be used to purchase prescriptions or to
reimburse copays or coinsurance related to prescriptions.)
Your copays are applied toward your medical plan’s annual
out‑of‑pocket maximum. Once you meet your annual
out‑of‑pocket maximum, eligible prescriptions are paid at
100% for the rest of the calendar year.
If you are in the Saver Plan option, in most cases you will
pay the full price for your prescription drugs until you
meet the Saver Plan’s network annual deductible. Once
you meet your network annual deductible, you will pay
the required copay or coinsurance. (The exceptions are
medications on the OptumRx list of approved preventive
medications, which are not subject to the Saver Plan’s
network annual deductible. See Preventive medications
not subject to the Saver Plan’s network annual deductible
later in this chapter for details.) Your copays are applied
toward the Saver Plan’s annual out‑of‑pocket maximum.
Once you meet your annual out‑of‑pocket maximum,
eligible prescriptions are paid at 100% for the rest of the
calendar year.
For all AMP options, the pharmacy benefit provides
discounted prices on generic and brand‑name drugs that
are covered on the formulary and filled at an eligible
network pharmacy. If, at the time your prescription is filled,
the discounted price available is lower than your copay,
you will be charged the lower amount, which may include a
dispensing fee.
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PHARMACY BENEFITS
Formulary generic drugs
Up to 30‑day supply
31‑ to 60‑day supply
61‑ to 90‑day supply
High-cost generic drugs are not
covered when a therapeutically
equivalent, lower-cost generic
is available.
Formulary brand-name drugs
Up to a 30‑day supply.
More than a 30 day-supply must
be purchased through mail order.
$4 copay
$8 copay
$12 copay
Filling your prescriptions
• Present your plan ID card at a Walmart or Sam’s Club
pharmacy.
• Prescription refills are available after 75% of your
previous prescription has been used.
• See Pharmacy options on the previous page for
additional information.
Greater of $50 or
25% of allowed cost
Non-formulary drugs
Not covered
Specialty drugs
Available only at Walmart
Specialty Pharmacy or
Optum Specialty Pharmacy
Greater of $50 or
20% of allowed cost
When purchasing mail-order drugs:
• You may purchase mail‑order prescriptions through a Walmart Home Delivery Pharmacy or OptumRx Mail‑Order Pharmacy,
regardless of your work location or AMP option.
• Your cost for a 90‑day supply is three times the cost of a 30‑day supply purchased at a Walmart or Sam’s Club pharmacy,
as listed above.
TYPES OF DRUGS
Generic drug: A generic drug is a lower‑cost equivalent of
a brand‑name drug. When a generic equivalent becomes
available, the brand‑name drug will no longer be covered.
Generic equivalents work like the brand‑name drug
in dosage, strength, performance, and use, and must
meet the same quality and safety standards. All generic
drugs must be reviewed by the United States Food and
Drug Administration (FDA). For more information, visit
One.Walmart.com.
Brand-name drug: A covered brand‑name drug is a drug
manufactured by a single manufacturer that has been
evaluated for safety and effectiveness when compared to
similar drugs treating the same condition and identified for
inclusion on the covered brand‑name drug list.
Specialty drug: Specialty drugs are used to treat complex
conditions such as cancer, growth hormone deficiency,
hemophilia, hepatitis C, immune deficiency, multiple
sclerosis, and rheumatoid arthritis. Specialty drugs require
an enhanced level of service, whether administered by
a health care professional, self‑injected, or taken orally.
(Medications used to treat diabetes are not considered
specialty medications.)
CONTRACEPTIVES FOR WOMEN
The AMP covers all FDA‑approved contraceptive methods,
including approved over‑the‑counter (OTC) variations for
women, as required by the Affordable Care Act. The AMP
covers certain FDA‑approved generic contraceptives (and
brand‑name contraceptives when medically necessary) at
100%, with no deductible, for women who are capable of
bearing a child, when the drug is prescribed by a physician.
If your attending physician believes a brand‑name
contraceptive is medically necessary, you may file a
claim for coverage of the brand‑name drug. See Filing a
pharmacy benefit claim at the end of this chapter.
HIV PREVENTION
The AMP covers preexposure prophylaxis (“PrEP”)
with effective antiretroviral therapy at 100%, with no
deductible, when the drug is prescribed by a physician
to a person at high risk of becoming infected with HIV.
PREVENTIVE MEDICATIONS NOT SUBJECT
TO THE SAVER PLAN’S NETWORK
ANNUAL DEDUCTIBLE
If you are enrolled in the Saver Plan, certain preventive
medications are covered under the Saver Plan before you
meet the Plan’s network annual deductible. Prescription
drugs that can keep you from developing a health condition
are considered “preventive medications.” If you are taking
prescribed drugs for certain health issues, such as high
blood pressure, high cholesterol, etc., you may be eligible
to get these medications at no cost before you meet
your Saver Plan’s network annual deductible. OptumRx
maintains the list of approved preventive medications. For
more information, call OptumRx at 844-705-7493.
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PREVENTIVE OVER-THE-COUNTER
MEDICATIONS
The AMP covers certain generic over‑the‑counter (OTC)
preventive care medications at 100% when they are
prescribed by a physician and purchased at an OptumRx
network pharmacy. You will need to present your plan ID
card and a prescription from your physician at the time
of purchase. Covered OTC preventive care medications
are those required under the Affordable Care Act. If
your physician believes a brand‑name preventive OTC
medication is medically necessary rather than a generic,
the physician can file an appeal with OptumRx for coverage
of the brand‑name drug, or you can file a claim for the
brand‑name drug under the procedures listed in the Filing
a pharmacy benefit claim section of this chapter.
Some common preventive OTC medications identified by
the United States Preventive Services Task Force (USPSTF)
are listed in the Preventive over-the-counter medications
chart below. For a current list of covered preventive care
OTC medications, go to One.Walmart.com or call OptumRx
at 844-705-7493.
PREVENTIVE OVER‑THE‑COUNTER MEDICATIONS
Recommended by the U.S. Preventive Services Task Force
(USPSTF)
Oral fluoride
By prescription when appropriate for
children 6 months to 6 years of age
Folic acid
By prescription for all women planning or
capable of pregnancy
Generic aspirin
Bowel prep
agents
By prescription for adults age 45 to
59 who have 10% or greater 10‑year
cardiovascular disease risk, are not at
increased risk for bleeding, have life
expectancy of at least 10 years and are
willing to take low‑dose aspirin for at least
10 years; low‑dose aspirin (81mg/d) by
prescription after 12 weeks of gestation
in pregnant women at high risk for
preeclampsia
By prescription when appropriate for a
screening colonoscopy for adults age 45
and over
MEDICATIONS THAT REQUIRE
PRIOR AUTHORIZATION
Prior authorization is required before some medications
can be covered by the AMP. OptumRx may ask your
physician to provide additional information. This is called
a “coverage authorization.”
After OptumRx receives the required information, it will
notify you and your physician (usually within two business
days) to confirm whether coverage is authorized. If it is
determined that the prescription is not a covered benefit
under the AMP, it will not be paid. You may appeal this
decision, as described in the Claims and appeals chapter.
If you choose to fill the prescription without prior
authorization, you must pay the full retail cost, even if
the prescription would have been authorized if you had
waited. The amount paid will not be applied toward your
out‑of‑pocket maximum.
For questions about prior authorizations, call OptumRx at
844-705-7493.
SPECIALTY REDIRECTION PROGRAM
If you receive infused or injected specialty medications,
this optional program supports a transition of services
from a hospital setting to alternative sites of care such
as a physician’s office, infusion suite, or your home.
Program clinicians evaluate appropriate infusion sites
based on detailed case reviews and will provide you with
proposed alternative sites of care. For more information
call OptumRx or your health care advisor at the number
on your plan ID card.
MEDICATIONS WITH QUANTITY LIMITS
Certain medications have limits on the quantity you
can receive per prescription, based on FDA dosage
guidelines. A list of these medications can be found
on One.Walmart.com.
Prescriptions for quantities greater than the FDA‑approved
quantity are not covered under the AMP. If you choose to
fill the prescription, you must pay the full retail cost.
What is not covered by
the pharmacy benefit
Medications not covered by the pharmacy benefit include
but are not limited to:
• Compound medications, which consist of two or more
ingredients that are measured, prepared or mixed
according to a prescription order. Select compounded
ingredients will not be covered. These may include
ingredients that are not approved by the FDA or are
available over‑the‑counter.
• Over‑the‑counter drugs, with the exception of insulin,
when a state does not require a prescription for it.
Certain over‑the‑counter drugs are covered as part of
the preventive care benefit under the Affordable Care
Act, when a prescription is provided. See Preventive
over-the-counter medications earlier in this chapter for
more information.
• Prescriptions filled at a pharmacy other than a Walmart or
Sam’s Club pharmacy (except as noted).
• Prescriptions filled by a pharmacy that is not an eligible
pharmacy for your medical plan option.
• Prescription drugs that are not included on the formulary.
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Filing a pharmacy benefit claim
When you fill a prescription at an eligible network pharmacy,
you do not need to file a claim. However, if you are unable
to use your card at a network pharmacy or if you disagree
with the amount you must pay, you can file a claim with
OptumRx. Your claim must be submitted in writing within
18 months of the date you had the prescription filled (or
attempted to have it filled). If the prescription is an eligible
prescription, it will be paid in accordance with the terms of
the pharmacy benefit.
Call OptumRx at 844-705-7493 for a claim form, or visit
One.Walmart.com. Claims are processed according to the
terms described in the Claims and appeals chapter.
If your claim is denied, you have a right to appeal. Appeals
are processed according to terms described in the Claims
and appeals chapter.
Privacy and security
When you purchase prescription drugs through a Walmart
or Sam’s Club pharmacy or, if eligible, an OptumRx network
pharmacy, your personal and medical information is kept
confidential. All network pharmacies are covered by and
adhere to applicable state and federal regulations, including
the Health Insurance Portability and Accountability Act of
1996 (HIPAA), which protects the privacy of personal health
information. Walmart values the trust that our associates
place in us. Earning that trust is consistent with our core
value of respect for the individual. For more information,
see HIPAA notice of privacy practices in the Legal
information chapter.
• Prescription drugs with over‑the‑counter equivalents.
• Prescription drugs purchased through a pharmacy discount
program.
• Drugs for which prior authorization has not been secured,
in cases where prior authorization is required.
• Prescription drug claims that are reduced, subsidized,
or paid by another health plan, insurance provider, or
pharmacy discount program. The AMP does not coordinate
benefits for pharmacy claims.
• Prescription drugs that are dispensed, infused, or injected
during an in‑patient treatment or that are covered by the
AMP as a medical benefit rather than a pharmacy benefit.
This list is not meant to be an all‑inclusive list of excluded
drugs and medications. For questions about excluded drugs
and medications, call OptumRx at 844-705-7493.
Pharmacy discounts for prescriptions
not covered
If a prescription is covered by the pharmacy benefit, the
appropriate copay or coinsurance will apply. However, if
the prescription is covered under the AMP but ineligible for
coverage under the pharmacy benefit (e.g., it is being filled
too soon or is prescribed for off‑label use), the prescription
will not be covered by the pharmacy benefit and is not
eligible for the pharmacy discount described in this section.
If you are enrolled in the AMP, you are eligible for a
pharmacy discount on certain drugs not covered by the
pharmacy benefit. The discount varies depending on the
drug prescribed. Prescriptions purchased with the retail
pharmacy discount do not count toward your network
annual deductible or out‑of‑pocket maximum.
To use the pharmacy discount, present your plan ID card
to the pharmacy when you pick up your prescription. If
the prescription is not covered by the pharmacy benefit,
the retail pharmacy will automatically discount the cost
of the drug.
For information, contact OptumRx at 844-705-7493.
Manufacturer assistance and other
discounts or coupons
Discounts, coupons, pharmacy discount programs,
debit cards, or similar arrangements provided by drug
manufacturers or pharmacies to assist you in purchasing
prescription drugs (including any prescription drug
discounts/coupons provided to pharmacies when you
fill a prescription) do not count toward your annual
out‑of‑pocket maximum. In addition, if you have coverage
under the Saver Plan, these charges do not count toward
your annual deductible.
Health savings
account (HSA)
HSA advantages: tax breaks and Walmart contributions
HSA eligibility
Opening your HSA
Contributions to your HSA
Paying qualified medical expenses through your HSA
Investing your HSA
If you leave the company or are no longer enrolled in the Saver Plan
Closing your HSA
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Health savings account for Saver Plan participants
If you are enrolled in the Saver Plan and want to save money on qualified medical expenses, the
HSA is a great option. Your HSA contributions are tax‑free and the company will match them
dollar‑for‑dollar, up to set limits. Your account balance earnings are also tax‑free and, as the
money grows from year to year, you can use it to pay for current or future medical expenses.
RESOURCES
Find What You Need
Online
Other Resources
Establish an account or change your
contribution amount
Log on to One.Walmart.com
Call People Services at 800-421-1362
Access your HSA
Log on to MyHealthEquity.com
Call HealthEquity at 866-296-2860
If you are logging in for the first time as a
member and have not already established
a user ID and password, click the “Begin
Now” button.
HealthEquity is the HSA administrator
and custodian.
Get a list of qualified medical expenses
(I.R.C.§ 213(d))
irs.gov
Get information on contribution
limits, eligibility, and tax reporting
responsibilities associated with an HSA
Call HealthEquity at 866-296-2860 or
contact your tax advisor
What you need to know about the HSA
• You must be enrolled in the Saver Plan to open and contribute to an HSA through this program.
• Walmart will match on a pretax basis each dollar you contribute, up to the matching limit.
• The HSA allows you to pay for qualified medical expenses (as defined by the IRS) with tax‑free dollars.
• The HSA accepts rollover contributions from other eligible HSAs.
• If you accept the HSA’s terms and conditions, pass the customer identification process, and take the necessary steps
to open your account, you will receive a welcome kit at your home address. Your account will be considered open on
the effective date of your Saver Plan coverage.
• You are not eligible to make HSA contributions for any month in which you travel on Walmart business outside the U.S.
and are covered under the GeoBlue policy, which provides health benefits for associates traveling internationally on
business. Consult your tax advisor if you have questions about the amount to reduce your contributions based on your
individual circumstances.
• The health savings account is offered through HealthEquity.
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HSA advantages: tax breaks and
Walmart contributions
If you’re enrolled in the Saver Plan, the HSA offers you:
• Walmart contributions to your HSA to match your pretax
contributions, dollar‑for‑dollar up to the matching limit.
• The ability to contribute pretax dollars to the account
through payroll deductions.
or health reimbursement account (HRA). Exceptions
include some disease‑specific coverage; dental, vision,
long‑term care, and disability coverage; accident policies
such as critical illness insurance and accident insurance,
and others.
• You are enrolled in Medicare.
• You are enrolled in Medicaid.
• You are covered under TRICARE.
• The ability to roll over funds from prior HSAs.
• You have received medical services from the U.S.
• The ability to pay for qualified medical expenses with
tax‑free dollars through the account, including easy access
to the money in your account using the debit card you will
receive. You can also access the funds in your account by
logging in to MyHealthEquity.com.
HealthEquity is the HSA administrator/custodian
with which Walmart has contracted to receive HSA
contributions from Walmart’s payroll. To receive the
Walmart contribution to your HSA or make pretax
contributions through payroll deduction, you must maintain
an open account with HealthEquity and continue medical
coverage through the Saver Plan. If you have an HSA with
another custodian, Walmart will not provide the Walmart
contribution to that HSA or allow you to make pretax
contributions through payroll deduction for that HSA.
Interest earnings and capital gains on the balance in your
account are not taxed during the period in which the funds
remain in your account. In addition, all HSA funds withdrawn
for qualified medical expenses are tax‑free.
You will have the opportunity to invest your account balance
once that balance reaches a certain amount. Investments
are not guaranteed or FDIC‑insured.
The balance in your HSA rolls over from year to year,
increasing your savings for future medical expenses. You
own the balance in your account, and can save it, invest
it in funds offered through your custodian, or spend it on
qualified medical expenses.
NOTE: State tax law with respect to HSAs may differ from
federal tax law in certain states, including California and
New Jersey. Please consult your tax advisor or HealthEquity
if you have questions about either the federal or state tax
implications of a health savings account.
HSA eligibility
You must be a Saver Plan participant to contribute to an
HSA through this program.
Even if you are enrolled in the Saver Plan, you cannot
contribute to an HSA if:
• You are covered under any other health plan that is not a
qualified high‑deductible health plan, including a general
purpose health care flexible spending account (FSA)
Department of Veterans Affairs during the preceding
three months, other than benefits for preventive care or a
service‑connected disability. Mere eligibility for Veterans
Affairs benefits does not disqualify you from contributing
to an HSA.
• You have received medical services at an Indian Health
Service (IHS) facility during the preceding three months.
• You can be claimed as a dependent on another person’s
tax return.
Other restrictions may apply. For further information,
please call HealthEquity at 866-296-2860.
Your dependent’s status does not affect your ability
to contribute to an HSA. For example, your covered
spouse/partner’s Medicare status will not affect your
ability to contribute to an HSA.
If you are a Saver Plan participant and also enrolled in
critical illness insurance, you’re not eligible for the major
organ transplant rider under that coverage due to IRS
guidance suggesting that such coverage would be viewed
as non‑high‑deductible plan coverage.
You are responsible for determining if you are eligible for
an HSA.
During the Plan year, you may be required to confirm
account eligibility to continue contributions (for example,
if you become Medicare‑eligible because of your age,
you may be asked to verify that you have not enrolled
in Medicare). In certain cases, Medicare enrollment can
be retroactive (such as if you delay your enrollment past
age 65) and, if that occurs, you will also lose eligibility to
make HSA contributions retroactively. If you are eligible
for, or are enrolling in, Medicare, you should carefully
evaluate your participation in the HSA to avoid penalties
for excess contributions.
The Saver Plan is a qualified high‑deductible health plan
(HDHP) subject to ERISA and to requirements of federal
law that allow you to contribute to an HSA. Walmart does
not, however, insure the health savings account described
in this chapter. It is Walmart’s intention to comply with U.S.
Department of Labor guidance specifying that an HSA is
not subject to ERISA when the employer’s involvement with
the HSA is limited. Accordingly, the HSA is not established
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or administered by Walmart or the Plan. Instead, the HSA is
established by the associate during the benefits enrollment
process and administered by HealthEquity.
customer identification process required to open an HSA.
If HealthEquity requires additional information to complete
this process, it will contact you.
If you have non‑high‑deductible health plan coverage
through Walmart or any other employer (e.g., your eligible
spouse/partner’s employer), including a general purpose
flexible spending account (FSA) or a health reimbursement
account (HRA), you are generally ineligible to make HSA
contributions (but you can enroll in the Saver Plan). There
are exceptions to this rule for “limited purpose” FSAs/
HRAs, which can be used for dental or vision coverage
only, or for “post‑deductible” FSAs/HRAs, which provide
coverage only after you satisfy the deductible under an
HDHP. For information, contact HealthEquity by phone at
866-296-2860 or online at MyHealthEquity.com.
You are not eligible to make HSA contributions for any
month in which you are traveling on Walmart business
outside the U.S. and are covered under the GeoBlue policy,
which provides health benefit coverage for Walmart
associates traveling internationally on business. Consult your
tax advisor if you have questions about the amount to reduce
your contributions based on your individual circumstances.
If you make or receive an ineligible contribution to your
HSA, excise taxes may apply unless you remove the
contribution by certain deadlines. For more information
about Medicare, HSA eligibility, or how to correct
ineligible contributions, contact your tax advisor or review
IRS Publication 969, Health Savings Accounts and Other
Tax-Favored Health Plans. You can also call 800 Medicare
(800-633-4227), or visit medicare.gov.
Opening your HSA
When you enroll online in the Saver Plan, you choose the
amount you want to contribute to your account through
payroll deductions. You may change your contribution
amount at any time. See Setting up or changing your
contribution amount later in this chapter.
You’ll receive a welcome kit at the home address that
Walmart has in its records directly from HealthEquity, the
HSA custodian, generally within the following time frames:
• By the end of December if you enroll during Annual
Enrollment, or
• Within two to three weeks after your HSA is opened if you
enroll at any other time.
Your debit card will be included within the welcome kit.
Activate your debit card online at MyHealthEquity.com or
by calling HealthEquity at 866-296-2860.
No payroll withholding or employer contributions will be
deposited to your HSA until it is open. Your account will not
be considered open until you have successfully passed the
If any payroll withholding or employer contribution is made
before your account is open, the custodian will hold your
contribution and deposit it into your HSA when it is open.
If your account is not opened within a reasonable amount
of time, the funds withheld from your pay will be refunded
to you through your payroll check (less applicable payroll
taxes) and reported as wages on your Form W‑2. The
employer contribution, if any, will be returned to Walmart.
For questions about your account status, welcome kit, or
debit card, call HealthEquity at 866-296-2860 or go online
to MyHealthEquity.com.
Once HealthEquity confirms that your account is open
and you have completed your HSA election online, your
contributions to the account and Walmart’s matching
contributions will begin the following pay period. See When
company contributions are made later in this chapter.
If you do not open your HSA by December 1 of the
Plan year, you will forfeit your right to the company’s
contributions for that year, even if you are covered by the
Saver Plan during that year.
To transfer funds from a prior HSA, contact HealthEquity
at 866-296-2860.
For purposes of company funding and payroll deductions,
you must select HealthEquity as your HSA custodian when
you enroll. You may move your funds to another HSA
custodian at any time, but Walmart will provide company
funding and support ongoing payroll deductions only for
HSAs established with HealthEquity.
HSA FEES
The company pays the monthly maintenance fees if you
are enrolled in the Saver Plan and your HSA custodian is
HealthEquity. However, if you are enrolled in COBRA,
terminate employment with the company, otherwise
become ineligible for AMP coverage, or are no longer
enrolled in the Saver Plan, you will be responsible for
paying the monthly maintenance fees. These fees will be
deducted automatically from your HSA balance if any of
these events occur. Call HealthEquity at 866-296-2860
to learn about the fees for various HSA services. It is your
responsibility to check your HSA balance prior to using
funds to pay for services. Current rate and fee schedules
are available online at MyHealthEquity.com. The fee
schedule is also included in the welcome kit.
The company does not pay overdraft fees, excess
contribution fees, or lost card fees.
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Contributions to your HSA
Once you open your HSA, Walmart may make contributions
to your account as follows (as long as your account is open
and you are enrolled in the Saver Plan):
• Walmart matches your pretax contributions
dollar‑for‑dollar, up to the matching limit described
in the chart below.
• You may make pretax contributions to the account
through payroll deductions in any amount (of $5 or
more each pay period) up to the legal limit, taking into
account Walmart’s contributions. For administrative
purposes, contributions are generally based annually
on 26 pay periods.
• In addition to making contributions by payroll deduction,
you can contribute money directly to your HSA by mailing
a check to HealthEquity, or by electronic funds transfer
(EFT) once you have linked a personal bank account on
the HealthEquity website. Any such contributions count
toward the contribution limit stated in the chart below.
These personal contributions are made on an after‑tax
basis and are not eligible for the Walmart matching
contribution. Walmart does not track your after‑tax HSA
contributions; you bear the responsibility of making sure
you do not exceed the annual contribution limit.
• If your requested HSA contribution for a specific pay
period exceeds the amount of your paycheck after
deductions, no contribution or company match will be
made to your HSA for that pay period.
• With respect to your final paycheck, your HSA salary
reductions and corresponding employer match may
be reduced because of state law restrictions on salary
reduction or because your requested HSA contribution
exceeds the net amount of your payroll check
after deductions.
If you experience a status change event and switch from
associate‑only coverage to family coverage under the
Saver Plan during the year, Walmart will increase its
matching contribution to correspond with the matching
contribution limit for family coverage. If you switch from
family coverage to associate‑only coverage during the year,
the matching contributions that the company made prior to
the change will not be reduced. If this results in your having
contributions in your account above the annual maximum
contribution allowed under IRS guidelines, the excess
contributions must be withdrawn by the tax‑filing deadline
to avoid additional taxes.
ANNUAL CONTRIBUTION LIMITS
By law, the maximum annual contribution that can be
made to your account, including both the company’s
contributions and your contributions (pretax and
after‑tax), is:
• For 2022, $3,650 for individual coverage, or
• For 2022, $7,300 for family coverage.
The annual maximum contribution is the total contribution
from all sources (payroll contributions by the associate
and/or the company and personal contributions).
These amounts are indexed annually by the federal
government and are subject to change each year.
If two associates who are legally married are both eligible
to contribute to individual HSAs, the contribution limit for
2022 for both accounts combined is based on the maximum
amount that can be contributed for a family: $7,300. Note,
however, if either of the associates is age 55 or older
in 2022, the total combined contribution is increased
by $1,000 for each associate age 55 or older.
If two associates are in a relationship that meets the
definition of eligible dependent but is other than a legal
marriage, and they have family coverage, each associate
is eligible to contribute to an individual HSA up to the
maximum family contribution limit of $7,300 (provided that
neither associate can be claimed as a tax dependent on any
individual’s federal tax return). If either associate is age 55
or older in 2022, the maximum contribution is increased by
$1,000 for each associate.
YOUR CONTRIBUTIONS AND THE COMPANY’S CONTRIBUTIONS TO THE HSA
Your Saver Plan network
annual deductible
Company matching contribution:
$1 for $1 up to
2022 maximum annual contribution
(associate and company contributions combined)*
$3,000 (associate‑only coverage)
$6,000 (family coverage)
$350
$700
$3,650
$7,300
*If you are age 55 or over by 12/31/2022, you can contribute an additional $1,000 in 2022.
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It’s important to monitor contributions to your HSA —
there are adverse tax consequences if your contributions
exceed the annual limit set by the federal government.
Changes in coverage during the year or enrollment after
the beginning of the year can affect your contribution
limits. If you become aware during the year that combined
contributions to your HSA exceed the annual limit, you can
withdraw the excess contribution and the related interest
earnings before your income tax return for the year is due
(including extensions). For assistance and information, call
HealthEquity at 866-296-2860.
EARNING INTEREST ON YOUR HEALTH
SAVINGS ACCOUNT
The balance in your HSA earns interest. For interest rate
information on your account, contact HealthEquity at
866-296-2860 or go online to MyHealthEquity.com.
Your current interest earned along with the interest rate
schedule is available on your monthly statements.
WHEN COMPANY CONTRIBUTIONS ARE MADE
Walmart will match dollar‑for‑dollar the amount that you
contribute through payroll deduction each pay period, up to
the matching limit for your coverage, as shown in the chart
titled Your contributions and the company’s contributions to
the HSA. The company deposits this contribution, along with
any contribution you make through payroll deduction, into
your HSA shortly after each payroll deduction period ends.
SETTING UP OR CHANGING YOUR
CONTRIBUTION AMOUNT
You may change your contribution amount online at any
time during the year on a prospective basis.
To set up or change your contribution amount, log on to
One.Walmart.com and select “Online Enrollment.” Contact
People Services at 800-421-1362 if you need help setting up
your payroll deductions.
NOTE: Once you make the maximum annual contribution
(as stated in the chart on the previous page), your payroll
contributions automatically cease. It is your responsibility
to make a new contribution decision at the next Annual
Enrollment for the following calendar year.
IF YOU ARE AGE 55 OR OLDER
If you are age 55 or older, you can make additional “catch
up” contributions to your HSA by payroll deduction,
just like your regular contribution. For 2022, the catch‑
up contribution limit is $1,000. Call HealthEquity at
866-296-2860 for information.
If you also cover your spouse under the Saver Plan and your
spouse is age 55 or older, they may also be eligible to open
a second HSA and contribute catch‑up contributions. The
contribution limit for 2022 for both accounts combined is
based on the maximum amount that can be contributed for
a family: $7,300. If either you or your spouse is age 55 or
older in 2022, the total combined contribution is increased
by $1,000 for each participant age 55 or older. The company
does not contribute funds or pay any fees associated with an
HSA for your dependent spouse.
If you cover an eligible partner under the Saver Plan and
that individual is other than a spouse, you and your partner
are each eligible to contribute to individual HSAs up to the
maximum family contribution limit of $7,300 (provided that
neither party can be claimed as a tax dependent on any
individual’s federal tax return). If either associate or partner
is age 55 or older in 2022, the maximum contribution is
increased by $1,000 for each participant age 55 or older.
The company does not contribute funds or pay any fees
associated with an HSA for your dependent partner.
Call HealthEquity at 866-296-2860 for information on
opening an HSA for your eligible spouse/partner.
Paying qualified medical expenses
through your HSA
When you have an eligible medical expense, you can decide
whether to pay out of your pocket or use the funds in your
HSA. Some people use their HSA for current expenses,
while others prefer to use the HSA as an account for future
health care expenses. Eligible expenses include health
plan deductibles and coinsurance, most medical care and
services, dental and vision care, prescription drugs, and
over‑the‑counter drugs. In addition, amounts paid for
certain menstrual care products such as tampons and
pads are eligible medical expenses. These expenses must
not already be covered by your medical plan, and health
insurance premiums generally do not qualify. Refer to IRS
Publications 969 and 502 at irs.gov for information about
qualified medical expenses. You can also find information
about qualified medical expenses on One.Walmart.com and
MyHealthEquity.com.
THE HSA AND YOUR INCOME TAX RETURN
The funds in your HSA belong to you, but any money
used for nonqualified medical expenses is subject to
federal income tax as well as a 20% penalty if you are
under age 65. Make sure you save your receipts and other
records to show that you used your HSA funds for eligible
expenses. Remember that you are responsible for the
tax consequences associated with contributions to and
withdrawals from your HSA. Consult your tax advisor if
you have questions about your HSA and taxes.
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Investing your HSA
Once your account reaches a minimum balance of $1,000,
you can invest any amount over that balance in a selection
of over 20 investment funds available through HealthEquity.
Review the funds and learn more at MyHealthEquity.com
under “Investments.”
If you leave the company or are no
longer enrolled in the Saver Plan
The funds in your HSA belong to you as the account
holder, even if you enroll in COBRA, change medical plans,
change jobs, or leave the company. In these events, all fees
associated with the account become your responsibility.
Closing your HSA
All funds in your HSA belong to you. You may use these
funds for qualified medical expenses on a tax‑free basis
now and in the future. If you do not choose to maintain the
account, call HealthEquity at 866-296-2860 for information
on closing your account.
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The dental plan
Your dental plan
How the dental plan works
Filing a dental claim
What is covered under the dental plan
Limited benefits
What is not covered under the dental plan
Break in coverage
When dental coverage ends
If you leave the company and are rehired
If you drop coverage and reenroll
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The dental plan
The dental plan covers a wide range of services, with no deductible for preventive care or
orthodontics. Plus, when you use network dentists, you’ll save money while protecting one of your
biggest assets—your smile.
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RESOURCES
Find What You Need
Online
Other Resources
Get a listing of Delta Dental
network dentists
Go to One.Walmart.com or
deltadentalar.com
Get answers to questions
about your dental claims
and to contact Delta Dental
Customer Service
Go to deltadentalar.com and select
“Login/Register” to create your account
Get a claim form if you use a
nonparticipating dentist
Go to One.Walmart.com or
deltadentalar.com
Call Delta Dental at 800-462-5410
or People Services at 800-421-1362
Call Delta Dental at 800-462-5410
What you need to know about the dental plan
• If you are an eligible associate, you may purchase dental coverage to assist with preventive, basic, and major dental care
as well as with orthodontia expenses. See the Eligibility and enrollment chapter for information on eligibility.
• Delta Dental of Arkansas administers the dental plan benefit.
• Once you meet the dental plan’s annual deductible, the dental plan pays benefits of up to $2,500 per covered person
per calendar year and a lifetime maximum orthodontia benefit of $1,500 per covered person. The annual deductible
does not apply for preventive and diagnostic services or orthodontia.
• Dental plan coverage must remain in effect for two full calendar years.
• Orthodontia is covered after a 12‑month waiting period.
• If you have medical coverage with the Associates’ Medical Plan (AMP), both the dental and medical information are on
your plan ID card. If you are enrolled in an HMO or if you have dental‑only coverage, you will receive a Delta Dental ID
card. Your ID cards will be mailed to your home address on record at Walmart.
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Your dental plan
The dental plan is available to you if you are an hourly
or management associate. Coverage is also available
to your eligible dependents, with the exception of
spouses/partners of part‑time associates, temporary
associates, and part‑time truck drivers. The dental plan
is administered through Delta Dental.
The dental plan benefit is self‑insured, which means
benefits are not paid by an insurance company.
Delta Dental administers the dental plan and has been
delegated the fiduciary authority to make determinations
with respect to claims for benefits and the first‑level
appeal of a claim that has been denied.
Once you enroll in the dental plan, your coverage must
remain in effect for two full calendar years. You can add or
remove a dependent during Annual Enrollment or due to a
status change event, but you must maintain a minimum of
associate‑only coverage for two full calendar years.
CHOOSING A COVERAGE LEVEL
When you enroll in the dental plan, you also select the
eligible family members you wish to cover:
• Associate only
• Associate + spouse/partner (except for part‑time hourly
associates, temporary associates, or part‑time truck drivers)
• Associate + child(ren), or
• Associate + family (except for part‑time hourly associates,
temporary associates, or part‑time truck drivers).
For information on dependent eligibility and when
dependents can be enrolled, see the Eligibility and
enrollment chapter.
How the dental plan works
The dental plan covers four types of dental services:
• Preventive and diagnostic care coverage includes oral
examinations and cleanings and related services. You do not
have to meet the annual deductible before the dental plan
covers these services. Charges you incur for preventive and
diagnostic care, if any, do not apply toward your deductible.
• Basic care coverage includes fillings, nonsurgical
periodontics, and root canal therapy, and begins after you
meet the annual deductible.
• Major care coverage includes surgical periodontics,
crowns and dentures and begins after you meet the
annual deductible.
• Orthodontia coverage begins after an individual receiving
orthodontia services has been covered under the dental
plan for 12 months; you do not have to meet the annual
deductible before receiving orthodontia benefits.
Charges you incur for orthodontia care do not apply
toward your deductible.
NOTE: The 12‑month waiting period for orthodontia
coverage is waived for:
• Localized associates and their covered dependents, and
• Enrolled participants who have previously met their full
waiting period.
COVERAGE UNDER THE DENTAL PLAN
Annual deductible
Waived for preventive and diagnostic care and
orthodontia care
Maximum benefit
Does not apply to orthodontia care
$75 per person/$225 per family
$2,500 per covered person per calendar year
Preventive and diagnostic care
Charges (if any) do not count toward
annual deductible
Basic care
Including fillings, non‑surgical periodontics, and
root canal therapy
Major care
Including surgical periodontics, crowns, and dentures
Orthodontia (12-month wait)
Charges do not count toward annual deductible
or maximum benefit
Delta Dental
PPO dentists
Delta Dental
Premier dentists
Non-network
dentists
100% covered; no annual
deductible applies
80% covered;* no annual
deductible applies
* In areas served by an insufficient number of PPO
dentists, as determined by facility location, services are
covered at 100%. Go to One.Walmart.com for details.
80% of maximum
plan allowance; no
annual deductible
80% of maximum plan allowance after annual deductible is met
50% of maximum plan allowance after annual deductible is met
80% of maximum plan allowance up to $1,500 lifetime maximum orthodontia
benefit per person; no annual deductible applies
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After you meet the annual deductible (if applicable) and
complete any applicable waiting period, the dental plan pays
a percentage of the maximum plan allowance (MPA) for
covered expenses.
MAXIMUM PLAN ALLOWANCE (MPA)
The MPA is the maximum amount the dental plan pays for
covered dental services. The MPA applies to network and
out‑of‑network dental services.
For covered network services, the MPA is that portion of a
provider’s charges covered by the dental plan as determined
by the provider’s contract with Delta Dental of Arkansas.
Network providers agree to accept an amount negotiated
by Delta Dental for covered services as payment in full,
subject to applicable deductible and coinsurance amounts.
For covered out‑of‑network services, the MPA can differ
by state and is derived from a variety of factors, including
data from fees on claims and fee filings submitted by the
dentist. If you see a non‑network dental provider, the dental
plan pays a percentage based on the lesser of the MPA or
the provider’s actual billed charges for a covered procedure.
If the provider’s billed charges exceed the Plan’s MPA,
you are responsible for paying 100% of the difference. For
additional information, call Delta Dental at 800-462-5410.
KNOW WHAT YOU’LL OWE:
GET A PRETREATMENT ESTIMATE
You are not required to get pre‑approval of any dental
treatments. But by having your dentist submit a proposed
treatment plan, you can learn how much you can expect the
dental plan to pay for a procedure or course of treatment
before the work is done. It is recommended that a proposed
treatment plan be submitted for treatment expected to
cost $800 or more. Delta Dental will provide a pretreatment
estimate of the amount that will be covered and may
suggest an alternate treatment plan if part of your dentist’s
treatment plan is ineligible for coverage.
To get a pretreatment estimate, ask your dentist to
complete a regular dental claim form and check the
“predetermination” box. The form should be mailed to:
Delta Dental of Arkansas
P.O. Box 15965
Little Rock, Arkansas 72231-5965
Delta Dental’s pretreatment estimate is not a guarantee
of payment. You still must file a claim for the services
rendered, as set out in the Claims and appeals chapter.
SAVE MONEY BY USING NETWORK DENTISTS
As a dental plan participant, you can use any dentist and
receive benefits for covered expenses under the Plan.
You will save money, however, when you use Delta Dental
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PPO and Premier dentists. Providers contracted with
Delta Dental agree to accept the dental plan’s maximum
plan allowance as payment in full for a covered procedure,
so you pay no more than the dental plan’s applicable
coinsurance percentage (after you meet any applicable
annual deductible). In addition, you may save time when you
use Delta Dental PPO or Premier dentists because they will
file your claims for you.
The Delta Dental PPO network is an extensive nationwide
network of dentists, but is not as widely available as the
Delta Dental Premier network. Refer to the chart entitled
Coverage under the dental plan earlier in this chapter for
details on how coverage terms for preventive and diagnostic
care may differ based on the availability of PPO dentists
in your area. To find a Delta Dental PPO or Delta Dental
Premier dentist, see Dental plan resources at the beginning
of this chapter.
IT PAYS TO USE NETWORK DENTISTS
Delta Dental
Premier dentists
and PPO dentists
Non-network
dentists
Yes
Yes
No
No
Yes
No
Dentist files claim
forms for you
Dentist accepts
maximum plan
allowance as payment
in full, subject to
annual deductible and
coinsurance
Dentist offers
discounted prices on
services covered by the
dental plan for Delta
Dental participants
Filing a dental claim
If you use a Delta Dental PPO or Premier dentist, your
dentist will file the claim for you. If you use a non‑network
dentist, you may need to file a claim. The dentist may be
paid directly from the dental plan if the dentist is a Delta
Dental PPO or Premier dentist. If you use a non‑network
dentist, the payment will be made to you.
Mail your claim to:
Delta Dental of Arkansas
P.O. Box 15965
Little Rock, Arkansas 72231-5965
You or your dental provider must file a claim in accordance
with the claims procedure within 18 months from date
of service or your claim will be denied. Not following the
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claims procedure described in the Claims and appeals
chapter, such as failure to mail your claim to the correct
address, may result in the denial of your claim.
Claims are determined under the time frames and
requirements set out in the Claims and appeals chapter.
You have the right to appeal a claim denial.
IF YOU HAVE COVERAGE UNDER MORE THAN
ONE DENTAL PLAN
If you or a family member have coverage under the dental
plan and are also covered under another dental plan (for
example, your spouse/partner’s company plan), coordination
of benefits may apply. The dental plan has the right to
coordinate with other plans you are covered under so the
total dental benefits payable will not exceed the level of
benefits otherwise payable under the dental plan.
When you are covered by more than one plan, one of the
plans is designated the primary plan. The primary plan
pays first and ignores benefits payable under other plans
when determining benefits. Any other plan is designated
as a secondary plan that pays benefits after the primary
plan. A secondary plan reduces its benefits by the amount
of benefits payable under “other plans” and may limit the
benefits it pays.
You must follow the primary insurance terms in order for
the dental plan to pay as secondary payer.
These rules apply whether or not a claim is made under the
other plan. If a claim is not made, benefits under the dental
plan will be delayed or denied until an explanation of benefits
is received showing a claim made with the primary plan.
HOW THE DENTAL PLAN COORDINATES WITH
OTHER PLANS
If another plan
pays primary at:
And the dental
plan’s payment is:
The dental plan’s
total benefit is:
Example 1
Example 2
Example 3
80%
80%
0%
80%
100%
20%
0%
80%
80%
DETERMINING WHICH PLAN IS PRIMARY
A plan without a coordinating provision is always primary.
The dental plan has a coordinating provision. If all plans have
a coordinating provision, the following provisions apply:
• The plan covering the participant for whom the claim is
made, other than as a dependent, pays first and the other
plan pays second.
• For dependent children’s claims, the plan of the parent
whose birthday occurs earlier in the calendar year is primary.
• When the birthdays of both parents are on the same day,
the plan that has covered the dependent for the longer
period of time is primary.
• When the parents of a dependent child are divorced
or separated, or the domestic partnership or legal
relationship is terminated, and the parent with custody has
not remarried, that parent’s plan is primary.
• When the parent with custody has remarried, or entered
into a domestic partnership with another individual, that
parent’s plan is primary, the stepparent’s plan pays second
and the plan of the parent without custody pays last.
• When there is a court decree that establishes financial
responsibility for the health care expenses of the child,
the plan that covers the parent with financial responsibility
is primary.
• If these rules do not establish an order of benefit
determination, the plan that has covered the participant
for whom the claim is made for the longest period of time
is primary.
If you are covered under a right of continuation coverage
pursuant to federal or state law (for example, COBRA) and
you are also covered under another plan that covers you
as an employee, member subscriber, or retiree (or as that
person’s dependent), the latter plan is primary and the
continuation coverage is secondary. If the other plan does
not have this rule, and the plans do not agree on the order
of benefits, this rule does not apply.
What is covered under
the dental plan
The dental plan covers the services listed in this section,
subject to some limitations. If you have questions about
what is covered under the dental plan, call Delta Dental
at 800-462-5410.
PREVENTIVE AND DIAGNOSTIC CARE
Preventive and diagnostic care are covered without having
to meet the annual deductible.
Bitewing X-rays: Limited to four per calendar year.
Combined with panoramic X‑ray if done by same provider
on same day and processed as a full mouth series.
Cleaning (dental prophylaxis): One prophylaxis, including
cleaning, scaling and polishing of the teeth, is covered
twice during a calendar year. Two additional cleanings
are allowed during a pregnancy and up to three months
following delivery. Two additional cleanings are allowed for
heart disease, diabetes, and periodontal disease. Additional
periodontal maintenance allowed for periodontal disease.
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Fluoride treatment: Covered once in any consecutive
12‑month period for participants under age 19.
Full-mouth debridement: Limited to once per lifetime.
Full-mouth series or panoramic X-rays: Limited to
one procedure in any consecutive 60‑month period.
A full‑mouth series is any combination of 14 or more
periapical and/or bitewing X‑rays taken on the same date.
If the combination of separately billed intraoral images
(i.e., bitewings and periapicals) equals or exceeds the
number of films allowed for a full mouth series, the charges
for the images will be combined and deemed to comprise
a full mouth series. A benefit is paid only if no other full
mouth series or panoramic radiographic image has been
paid during the preceding 60 consecutive months.
Oral evaluations: Benefits are payable as follows:
• Routine oral evaluation: Two evaluations covered during
a calendar year.
• Comprehensive detailed oral evaluation or periodontal
evaluation: Initial comprehensive oral evaluation are
payable subject to the routine oral evaluation time
limitations. Subsequent oral evaluations submitted by the
same provider within three years are processed as routine
oral evaluations.
BASIC CARE
After you meet the annual deductible, the Plan pays 80% of
the maximum plan allowance for basic care.
Amalgam and composite resin fillings: Benefits are payable
once per tooth surface in any consecutive 24‑month period.
Endodontics: Includes pulp therapy and root canal therapy.
See Root canal therapy in Major care below.
Extractions: Nonsurgical extractions are covered once
per tooth.
Nonsurgical periodontics: Provided once per quadrant in
any consecutive 24‑month period.
Occlusal orthotic device (TMJ appliance): Benefits are
payable once every five years. Adjustments within six
months are not covered. One adjustment covered per
year thereafter.
Periodontal maintenance: Periodontal maintenance is
covered only if done 30 days or more after the completion
of surgical or nonsurgical periodontal treatment. Thereafter,
periodontal maintenance is allowed up to four times per
calendar year. This benefit is combined with any routine
cleanings performed during the same calendar year with a
combined limitation of four for that year.
Emergency evaluations performed by dentists are not
subject to the calendar year restriction.
MAJOR CARE
Periapical X-rays: Covered as needed.
Preventive resin restoration: Covered for first and second
permanent molars with unrestored occlusal surface for
participants under age 19. Limited to one treatment per
tooth every five years.
Pulp vitality tests: Covered if same provider does no other
definitive procedure the same day.
Risk assessment: Covered once every three‑year period for
children age 3 through age 18.
Sealant repair: Covered for first and second permanent
molars with unrestored occlusal surface for participants
under age 16. Not covered during the first 24 months of the
initial placement of the sealant. Limited to one treatment
per tooth every 24 months. Not covered when the tooth has
previously received a preventive resin restoration.
Sealants: Covered for first and second permanent molars
with unrestored occlusal surface for participants under
age 16. Limited to one treatment per tooth per lifetime.
Not covered when the tooth has previously received a
preventive resin restoration.
Space maintainers: Covered for participants age 13 and
under. Limited to one appliance per space (quad/arch)
extraction site in any consecutive 60‑month period. Repair
or replacement of a space maintainer is not covered.
After you meet the annual deductible, the Plan pays 50% of
the maximum plan allowance for major care.
Anesthesia/general anesthetics and IV sedation: Covered
only when provided in the following circumstances:
• The patient suffers from a medical condition that prevents
him or her from holding still (including but not limited to
dystonia, Parkinson’s disease, autism)
• The patient is under age 4, or
• In connection with certain covered oral surgical procedures.
Complete and partial removable dentures and partial
fixed bridges: Covered when the denture or bridge is the
professionally accepted, standard course of treatment.
• Includes replacement or addition of teeth to dentures,
partials or fixed bridgework.
• When alternate treatment plans are available, the dental
plan covers the professionally accepted, standard course
of treatment. For example, a bridge is allowed only
when a partial denture will not suffice. See Alternative
treatment plans in Limited benefits later in this chapter.
• Full or partial or removable dentures or fixed bridges are
not payable for patients under the age of 16.
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• A denture that replaces another denture or fixed bridge, or
a fixed bridge that replaces another fixed bridge, is covered
only if the existing denture, partial denture, or fixed bridge
is at least five years old and cannot be repaired.
Crowns, cast restorations, inlays, onlays, and veneers:
Covered only when the tooth cannot be restored by
amalgam or composite resin filling.
• Replacement is not covered unless the existing crown, cast
restoration, inlay, onlay, or veneer is more than five years
old and cannot be repaired.
NOTE: Accidents as a result of biting or chewing are not an
exception to the five‑year wait for crown replacements.
• For participants under age 12, benefits for crowns on vital
teeth are limited to resin or stainless steel crowns, unless
there is a history of root canal therapy or recession of
the pulp.
• Treatment is determined according to the alternate
treatment plan limitation. See Alternative treatment plans
in Limited benefits later in this chapter.
Implants: Surgical placement of an implant body is covered
once in every five‑consecutive‑year period.
• The abutment to support a crown is covered once in every
five‑consecutive‑year period.
• An implant or abutment‑supported retainer is covered
once in every five‑consecutive‑year period.
• An implant maintenance procedure is covered once in any
12‑consecutive‑month period.
• Implant removal is covered once in a lifetime per tooth.
Implants are not payable for patients under the age of 16.
Occlusal adjustment (limited): Covered only if done
six months or more after completion of initial restorative,
prosthodontic and implant procedures that include the
occlusal surface.
Oral surgery: Surgical extractions and extractions of
wisdom teeth, including preoperative and postoperative
care, except for those services covered under the
Associates’ Medical Plan. Oral sedation and/or nitrous oxide
(analgesia) are not covered. If oral surgery is performed in
a hospital setting, the dental plan covers oral surgeon fees
for such services for covered individuals not enrolled in the
Associates’ Medical Plan.
Outpatient or inpatient hospital costs and additional fees
charged by the dentist for hospital treatment: See Hospital
charges in What is not covered under the dental plan later
in this chapter.
Root canal therapy: Includes bacteriological cultures,
diagnostic tests, local anesthesia, and routine follow‑up
care. Payable once per tooth.
• Therapeutic pulpotomy is payable once per tooth until
age 21.
• Retreatment of a previous root canal is allowed once in a
consecutive 24‑month period.
Surgical periodontics: Treatment of the gums — osseous
surgery/soft tissue graft, provided in the same area once in
any consecutive 36‑month period.
ORTHODONTIA
After you have been a participant in the dental plan for
12 months, you are eligible for orthodontia assistance for
yourself (the associate). Each of your covered dependents
must also participate in the dental plan for 12 months
before becoming eligible for orthodontia assistance. If you
terminate coverage for any reason and reenroll, your (or
your covered dependent’s) prior time enrolled for coverage
will count toward the 12‑month waiting period.
NOTE: The 12‑month waiting period for orthodontia
coverage is waived for:
• Localized associates and their covered dependents, and
• Enrolled participants who have previously met their full
12‑month waiting period.
If the dentist submits a statement at the beginning of a period
of orthodontic treatment showing a single charge for the
entire treatment, benefits are paid in the following manner:
• The dentist receives an initial payment of up to $150
• A prorated portion of the remainder is paid every three
months based on the estimated period for treatment and
on continued eligibility, and
• The amount and number of payments are subject to
change if the charge or treatment period changes.
The dental plan covers only orthodontic treatment that
begins after the covered individual becomes eligible for
orthodontia assistance. Active orthodontic treatment is
deemed started on the date the active appliances are first
placed. Active orthodontic treatment is deemed completed
on the earlier of:
• The date on which treatment is voluntarily discontinued, or
• The date on which the active bands or appliances are
removed.
If an individual has had orthodontia treatment prior to
becoming eligible for orthodontia assistance under the
dental plan, treatment is available only if five years have
elapsed since the completion or discontinuance of that
orthodontic treatment plan.
Repair or replacement of an orthodontic appliance is
not covered.
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There are certain orthodontia assistance benefits that are
not covered. See What is not covered under the dental plan
later in this chapter.
Limited benefits
Alternative treatment plans: When alternative treatment
plans are available, the dental plan covers the professionally
accepted, standard course of treatment.
Transfer of treatment: If you transfer from the care of
one dentist to another during the course of treatment, or
if more than one dentist renders services for one dental
procedure, the dental plan pays no more than the amount it
would have paid if only one dentist had rendered services.
What is not covered under
the dental plan
The dental plan does not pay benefits for all types of
services. To determine if a service is covered, call Delta
Dental or submit a pretreatment estimate of benefits form.
Services that are not covered by the plan include, but are
not limited to, the following:
Accidental injury to sound, natural teeth: Expenses for
treatment of accidental injury to sound, natural teeth may
be covered under the medical plan. This exclusion does not
apply to accidental injuries as a result of biting or chewing;
these charges may be covered under the dental plan.
Beyond the scope of licensure or unlicensed: Services
rendered by a dentist beyond the scope of their license, or
any services provided by an unlicensed dentist.
Bridgework: Repair or recementing of bridgework during
the first six‑month post‑delivery period, and such services
received more often than once every five years.
Cosmetic purposes: Services performed for cosmetic
purposes or to correct congenital, hereditary, or
developmental malformations. This exclusion does not apply
to orthodontic services for the correction of malposed teeth.
Dentures: Repair or relining of dentures during the first
six‑month post‑delivery period, and such services received
more often than once every five years for repairs and once
every three years for relines and rebases.
Elective non-emergency dental services outside the U.S.
Elective non-necessary services: Services that are
not dentally necessary or that do not meet generally
accepted standards of care for treating the particular
dental condition, including decoration, personalization or
inscription of any tooth, device, appliance, crown, or other
dental work.
Experimental or investigational: Charges for treatment
or services, including hospital care, that are experimental,
investigational, or inappropriate, under protocols
established by Delta Dental.
Governmental agency: Services provided or paid for by any
governmental agency or under any governmental program
or law, except charges for legally entitled benefits under
applicable federal laws.
Hospital charges: Services performed in a hospital or
outpatient hospital setting, including but not limited to
provider and facility charges. This exclusion does not apply
to oral surgeon fees for participants not enrolled in the
Associates’ Medical Plan, subject to terms of the dental plan.
Occlusal guards: Devices serving to minimize effects of
bruxism (grinding) or other occlusal factors. This exclusion
does not apply to occlusal orthotic devices to treat
TMJ disorders.
Oral sedation: Oral sedation and/or nitrous oxide (analgesia).
Orthodontia care: Services in connection with treatment
for the correction of malposed teeth during the first 12
consecutive months that a participant is covered under the
dental plan.
Periodontal splinting: Charges for complete occlusal
adjustments or stabilizing the teeth through the use of
periodontal splinting.
Permanent restorations: Charges for bases, liners,
and anesthetics used in conjunction with permanent
restorations (fillings).
Prescription drugs and medicines: Written for dental
purposes.
Prosthetics, duplicates: Duplicate prosthetic devices
or appliances.
Retainers: Separate charges for retainers (appliances
intended to retain orthodontic relationship) or habit
appliances to address harmful behaviors such as thumb‑
sucking or tongue‑thrusting.
Services undertaken prior to effective date or during
the waiting period for orthodontia services: Charges
for courses of treatment, including prosthetics and
orthodontics, which are begun prior to the effective date
of coverage or before you are eligible to receive benefits
for orthodontia services.
Surgical corrections: Charges for services related to the
surgical correction of:
• Temporomandibular joint dysfunction (TMJ)
• Orofacial deformities, and
• Specified oral surgery procedures covered by the
Associates’ Medical Plan.
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Tooth structure: Services for restoring tooth structure lost
from wear, for rebuilding or maintaining chewing surfaces
due to teeth out of alignment or occlusion, or for stabilizing
the teeth.
premiums before or during the leave. For information
about making payments while on a leave of absence, see
When special arrangements are necessary to maintain
coverage in the Eligibility and enrollment chapter.
OTHER CHARGES NOT COVERED
• Any procedure performed for a temporary purpose
• Charges in excess of the maximum plan allowance
• Extraoral grafts
• Hypnosis or acupuncture
• Oral hygiene instruction and dietary instruction
• Plaque control programs
• Services covered by the Associates’ Medical Plan
• Services for which there is no charge
• Teledentistry
• Any other services not specifically listed as covered
• Charges covered by workers’ compensation or employers’
liability laws
• Services provided by a member of the participant’s family,
or
• Charges incurred as a result of war.
Break in coverage
There may be occasions in which you must make special
arrangements to pay your dental premiums to avoid a break
in coverage. These situations occur most commonly if you
are on a leave of absence or if your Walmart paycheck is
not sufficient to pay your full share of the cost of coverage
(such as after a reduction in hours). Failure to make your
premium payments by the due date may result in an
interruption in the payment of any benefit claims and/or
a break in coverage.
For details on the impact a break in coverage may have,
and on how to make personal payments to continue your
coverage, see When special arrangements are necessary to
maintain coverage in the Eligibility and enrollment chapter.
IF YOU GO ON A LEAVE OF ABSENCE
You may continue your coverage up to the last day of an
approved leave of absence, provided that you pay your
When dental coverage ends
Your coverage ends on your last day of employment or
when you are no longer eligible under the terms of the Plan.
Dependent coverage ends when your coverage ends or when
a dependent is no longer an eligible dependent (as defined
in the Eligibility and enrollment chapter). All benefits
cease on the date coverage ends, except for completion
of operative procedures in progress at the time coverage
ends. “Operative procedures” are limited to individual
crowns, dentures, bridges, and implants, and are considered
“in progress” only if all procedures for commencement
of lab work are completed and all operative procedures
are completed within 45 days of termination. The dental
plan does not pay benefits if you or a covered dependent
receive benefits for these post‑termination expenses from
another plan. You and/or your enrolled dependents may be
eligible for continued coverage through the Consolidated
Omnibus Reconciliation Act of 1985, as amended (COBRA).
See the COBRA chapter for information regarding COBRA
continuation coverage.
If your coverage is cancelled due to nonpayment of
premiums, coverage ends on the cancellation date. See
Paying for your benefits in the Eligibility and enrollment
chapter for information.
If you voluntarily drop coverage after a status change event
or at Annual Enrollment (after completing two full calendar
years of coverage), coverage ends as follows:
• After a status change event: coverage ends on the
effective date of the event. See Status change events in
the Eligibility and enrollment chapter for information
• At Annual Enrollment: coverage ends on December 31 of
the current year.
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If you leave the company and
are rehired
If you return to work for the company within 13 weeks,
you will automatically be reenrolled for the same coverage
you had prior to leaving the company (or the most similar
coverage offered under the Plan). If your break is 30 days
or less, the annual deductible and waiting period for
orthodontia assistance will not reset. If your break is greater
than 30 days, your annual deductible will be reset. If your
break is greater than 30 days but less than 13 weeks, and
you have already maintained coverage under the Plan for a
minimum of two years, you will have 60 days after resuming
work to drop or otherwise change the coverage in which
you were automatically reenrolled.
If you return to work after 13 weeks, you will be considered
newly eligible and may enroll for coverage under the time
periods and conditions described in the Eligibility and
enrollment chapter.
If you drop coverage and reenroll
If you drop coverage and reenroll within 30 days, you will
automatically be reenrolled for the same coverage you had
(or the most similar coverage offered under the Plan). In this
case, the annual deductible will not be reset.
If you drop coverage and reenroll after 30 days, you will be
considered newly eligible and may enroll for coverage under
the time periods and conditions described in the Eligibility
and enrollment chapter.
IF A DEPENDENT IS DROPPED FROM
COVERAGE AND REENROLLED
If a dependent child is dropped from coverage and then
determined to be eligible for coverage within 30 days,
the dependent will automatically be reenrolled in their
previous coverage (or the most similar coverage offered
under the AMP). The annual deductible will not reset.
If your dependent regains eligibility and is reenrolled after
30 days, they will be treated as a newly eligible dependent.
The associate may enroll them for coverage under the
time periods and conditions described in the Eligibility and
enrollment chapter.
The vision plan
The vision plan
How the vision plan works
How to use the plan
What is not covered
Breakage and loss of eyewear
Filing a vision claim
Break in coverage
When vision coverage ends
If you leave the company and are rehired
If you drop coverage and reenroll
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The vision plan
The vision plan helps you pay for routine eye exams, lenses, frames, and contact lenses, so you can
see clearly for years to come.
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RESOURCES
Find What You Need
Online
Other Resources
Locate a Walmart Vision Center or
Sam’s Club Optical provider
For detailed information about vision
plan coverage or to locate a VSP
network provider
Go to One.Walmart.com
Go to Walmart.VSPforme.com and enter your
member number
Call VSP at 866-240-8390
Get the cost for vision plan coverage
Go to One.Walmart.com
Call People Services at
800-421-1362
What you need to know about the vision plan
• Coverage under the vision plan is separate from the medical plan, which generally does not cover charges for
routine eye care. If you are interested in coverage for vision services not covered by the medical plan, you must
enroll separately in the vision plan.
• You may see any Walmart Vision Center, Sam’s Club Optical, or VSP network provider for care and receive the same
level of benefits. No benefits are available if you see a non‑network provider.
• You may purchase contact lenses online at WalmartContacts.com or SamsClubContacts.com, or from a VSP network
provider. VSP coordinates the amount of your purchase eligible for coverage. Go to Walmart.VSPforme.com or call
VSP at 866-240-8390 for details about the contact lens benefit.
• If you have medical plan coverage with the Associates’ Medical Plan (AMP), the VSP phone number will appear
on your plan ID card. If you are enrolled in an HMO or if you enroll for vision coverage only or dental and vision
coverage only, you will receive a VSP ID card, which will be mailed to your home address.
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The vision plan
Walmart offers the vision plan to help you pay for routine eye
care. The vision plan is administered through VSP. You may
access care under the vision plan through a Walmart Vision
Center or Sam’s Club Optical facility, or through a provider in
VSP’s nationwide network. Vision plan coverage is available to
you if you are an hourly or management associate. Coverage
is also available to your dependents, with the exception
of spouses/partners of part‑time associates, temporary
associates, and part‑time truck drivers.
CHOOSING A COVERAGE LEVEL
When you enroll in the vision plan, you also select the
eligible family members you wish to cover:
• Associate only
How the vision plan works
The vision plan covers a routine eye exam once every calendar
year, lenses once every calendar year, frames once every
calendar year, or contact lenses once every calendar year.
The vision plan pays benefits for prescription contact lenses
or prescription eyeglasses. If you choose contact lenses, you
will not be eligible for lenses or frames again until the next
calendar year. Benefits are paid as shown in the chart below.
Walmart providers and VSP network providers have agreed to
provide their services to covered associates for a prearranged
fee; all you pay is the applicable copay and the cost of any
non‑covered or elective items. VSP pays the rest directly to
the provider. Benefits will be paid only for covered services
provided through any Walmart Vision Center, Sam’s Club
Optical, or VSP network provider. No benefits are available
if you see a non‑network provider.
• Associate + spouse/partner (except for part‑time hourly
associates, temporary associates, or part‑time truck drivers)
• Associate + child(ren), or
Additional charges. Charges for any of the following items
are your responsibility. Call VSP at 866-240-8390 for
more information.
• Associate + family (except for part‑time hourly associates,
temporary associates, or part‑time truck drivers).
• Blended lenses
• Oversize lenses
For information on dependent eligibility and when
dependents can be enrolled, see the Eligibility and
enrollment chapter.
• Photochromic or tinted lenses other than Pink 1 or 2
allowance
• Laminated lenses
VISION PLAN BENEFITS
Routine exam copay
Once every calendar year
Walmart Vision Center
Sam’s Club Optical
VSP network providers
$4
Limitations apply for low-vision testing or supplemental testing for individuals whose vision
problems are not correctable with regular lenses.
Materials copay
$4
Applies with purchase of frames or lenses (but not contact lenses). Copay is charged only once
when frames and lenses are purchased together.
Progressive lens copay
$55
Lenses
• Single vision
• Lined bifocal
• Lined trifocal
• Lenticular
• Progressive multifocal
Frames
Once every calendar year
Contact lenses
Once every calendar year In lieu
of glasses
100% covered after copay
Standard lenses are covered after applicable copay. Check with your optical team for lenses
offered under benefit.
$130 allowance
Charges above the frame allowance are your responsibility.
$130 contact lens allowance
You may be charged an additional fee of up to $60 for fitting and evaluation. Charges above
the contact lens allowance are your responsibility.
NOTE: Sales taxes may apply and will reduce the vision benefit.
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• High‑index lenses
• Anti‑reflective coating
• Color coating
• Mirror coating
• Optional cosmetic processes
• Low vision care
• Cosmetic lenses, and
• Frames or contacts that cost more than your allowance.
How to use the plan
Follow these steps for your vision care.
STEP 1
STEP 2
STEP 3
To find a Walmart Vision Center or Sam’s Club
Optical provider, go to One.Walmart.com;
to find a provider in the VSP network, call
866-240-8390 or go to Walmart.VSPforme.com
and enter your member number.
When you make an appointment, identify
yourself as a VSP member and give the office
your name and date of birth, plus the patient’s
name (if different). The provider’s office
contacts VSP to verify your eligibility.
At your visit, pay your copay and any other
required amount directly to the Walmart
Vision Center or Sam’s Club Optical or VSP
network provider. The provider’s office arranges
for reimbursement and handles any other
administrative tasks required.
What is not covered
Some expenses are not covered under the vision plan,
including:
• Charges for eye exams, lenses, or frames that:
– you are not legally obligated to pay for or for which no
charge would be made in the absence of vision coverage
– exceed plan maximums
– are not necessary according to accepted standards of
ophthalmic practice, or not ordered or prescribed by
the attending physician or optometrist
– do not meet accepted standards of ophthalmic practice,
including charges for experimental or investigational
services or supplies
– are received as a result of eye disease, defect, or injury
due to an act of declared or undeclared war
– are for any condition, disease, ailment, or injury arising
out of and in the course of employment compensable
under a workers’ compensation or employers’ liability
law and were ordered before the patient became eligible
for coverage or after coverage ends
– are received free from any governmental agency by
compliance with laws or regulations enacted by any
federal, state, municipal, or other governmental body
– are paid for by another insurance plan (see If you have
coverage under more than one vision plan later in this
chapter), or
– are payable under any health care program supported
in whole or in part by federal funds or any state or
political subdivision.
• Medical or surgical treatment or supplies
• Professional services or eyewear connected with
orthoptics, vision training, subnormal vision aids,
aniseikonic lenses and tonography, and other services/
materials not covered by the vision plan
• Replacement of broken lenses or frames after one year
from purchase
• Replacement of lost lenses or frames unless the patient
is otherwise eligible under the frequency provisions,
as detailed in the Vision plan benefits chart on the
previous page
• Service contract fees
• Plano lenses (nonprescription lenses less than .50 diopter)
• Services from any non‑network providers — i.e., any
provider that is not affiliated with a Walmart Vision Center
or Sam’s Club Optical, or that is not a VSP network provider.
Breakage and loss of eyewear
If you’re covered under the vision plan and you damage
your eyewear within one year of purchase, you can return
to your network provider for replacement or repair. Some
warranties on eyewear may be longer than one year; check
with your eyewear provider for details.
Lost eyewear is not covered under the vision plan.
Filing a vision claim
When you use the vision plan, claims for services are
generally not required; see How to use the plan for a
description of payment arrangements. When it’s necessary
to file a claim—for example, if you are newly enrolled in
the vision plan when you see a provider and your personal
information is not yet on file with VSP—return to the
provider after your information is in the system and ask
the provider to file the claim on your behalf. Claims are
processed according to the terms described in the Claims
and appeals chapter.
IF YOU HAVE COVERAGE UNDER MORE THAN
ONE VISION PLAN
If you or a family member have coverage under the vision
plan and are also covered under another vision plan (for
example, your spouse/partner’s company vision plan),
coordination of benefits may apply. The vision plan has
the right to coordinate with other plans under which you
are covered so the total vision benefits payable will not
exceed the level of benefits otherwise payable under the
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vision plan. Under the vision plan, “other plans” refers
only to other plans administered by VSP. There is no
coordination‑of‑benefits provision with vision coverage
providers other than VSP. Plans referred to as “other plans”
are described in If you have coverage under more than one
medical plan in The medical plan chapter.
Break in coverage
There may be occasions in which you must make special
arrangements to pay your vision premiums to avoid a break
in coverage. These situations occur most commonly if you
are on a leave of absence or if your Walmart paycheck is
not sufficient to pay your full share of the cost of coverage
(such as after a reduction in hours). Failure to make your
premium payments by the due date may result in an
interruption in the payment of any benefit claims and/or
a break in coverage.
For details on the impact a break in coverage may have,
and on how to make personal payments to continue your
coverage, see When special arrangements are necessary to
maintain coverage in the Eligibility and enrollment chapter.
IF YOU GO ON A LEAVE OF ABSENCE
You may continue your coverage up to the last day of an
approved leave of absence, provided that you pay your
premiums before or during the leave. For information
about making payments while on a leave of absence, see
When special arrangements are necessary to maintain
coverage in the Eligibility and enrollment chapter.
If you have received covered vision services prior to your
leave, any applicable benefit frequency limitation under
the vision plan (i.e., eyeglass frames every calendar year)
will continue to apply after your return.
When vision coverage ends
Your coverage ends on your last day of employment or
when you are no longer eligible under the terms of the
Plan. Dependent coverage ends when your coverage ends
or when a dependent is no longer an eligible dependent
(as defined in the Eligibility and enrollment chapter).
You and/or your enrolled dependents may be eligible for
continued coverage through the Consolidated Omnibus
Reconciliation Act of 1985, as amended (COBRA). See
the COBRA chapter for information regarding COBRA
continuation coverage.
If your coverage is cancelled due to nonpayment of
premiums, coverage ends on the cancellation date.
See Paying for your benefits in the Eligibility and
enrollment chapter for information.
If you voluntarily drop coverage after a status change event
or at Annual Enrollment, coverage ends as follows:
• After a status change event: coverage ends on the
effective date of the event. See Status change events in
the Eligibility and enrollment chapter for information
• At Annual Enrollment: coverage ends on December 31 of
the current year.
If you leave the company and
are rehired
If you return to work for the company within 13 weeks,
you will automatically be reenrolled for the same coverage
you had prior to leaving the company (or the most similar
coverage offered under the Plan). If your break is greater
than 30 days but less than 13 weeks, you will have 60 days
after resuming work to drop or otherwise change the
coverage in which you were automatically reenrolled.
If you return to work after 13 weeks, you will be considered
newly eligible and may enroll for coverage under the time
periods and conditions described in the Eligibility and
enrollment chapter.
If you drop coverage and reenroll
If you drop coverage and reenroll within 30 days, you will
automatically be reenrolled for the same coverage you had
(or the most similar coverage offered under the Plan).
If you drop coverage and reenroll after 30 days, you will be
considered newly eligible and may enroll for coverage under
the time periods and conditions described in the Eligibility
and enrollment chapter.
If you have received covered vision services prior to your
absence, any applicable benefit frequency limitation under
the vision plan (i.e., eyeglass frames once every calendar
year) will continue to apply after your return.
IF A DEPENDENT IS DROPPED FROM
COVERAGE AND REENROLLED
If a dependent child is dropped from coverage and then
determined to be eligible for coverage within 30 days, the
dependent will automatically be reenrolled in the same
coverage you elect for yourself.
If your dependent regains eligibility and is reenrolled after
30 days, they will be treated as a newly eligible dependent.
The associate may enroll them for coverage under the
time periods and conditions described in the Eligibility and
enrollment chapter.
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COBRA
COBRA continuation coverage
COBRA qualifying events
Paying for COBRA coverage
How long COBRA coverage may last
When COBRA coverage ends
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COBRA
If you and/or your covered dependents lose medical, dental, or vision coverage because of a
qualifying event, a federal law known as “COBRA” may allow you to continue that coverage for
a set period of time at your own expense.
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RESOURCES
Find What You Need
Online
Other Resources
Contact People Services within 60 calendar
days of a divorce, legal separation, termination
of a relationship with a partner, or ineligibility
of dependents
Contact WageWorks (a HealthEquity company),
the COBRA administrator, for questions
regarding eligibility, enrollment, premiums,
and notification of a second qualifying event
Call People Services at 800-421-1362 or
provide notification in writing to:
Walmart People Services
508 SW 8th Street
Bentonville, Arkansas 72716-3500
Go to
mybenefits.wageworks.com
Call 800-570-1863
What you need to know about COBRA
• “COBRA,” which stands for Consolidated Omnibus Budget Reconciliation Act of 1985, may apply if a “qualifying
event” occurs that would otherwise cause you or a covered dependent to lose medical, dental, or vision coverage.
Qualifying events are described in this chapter. The Plan extends COBRA continuation coverage to you and all your
covered dependents.
• For medical, dental, and vision benefits, COBRA continuation coverage can continue up to 18 or 36 months, depending
on the qualifying event. The 18 months can be extended to 29 months under certain circumstances when a disability
is involved.
• If you experience a qualifying event and become eligible for COBRA benefits, your Resources for Living benefits
automatically continue for 18 months from the date of the qualifying event (or the maximum duration for which you
would be eligible for COBRA coverage). You do not have to enroll in COBRA coverage to continue your Resources for
Living benefits.
• The Plan contracts with WageWorks, a third‑party administrator, to administer COBRA. References to COBRA in this
section are to the Plan’s continuation coverage, which may be more favorable to participants and dependents than the
continuation coverage legally required under COBRA.
• There are strict notification rules and time limits for enrolling in COBRA continuation coverage, as described in this
chapter. Please read this chapter carefully—failure to adhere to these rules can result in the loss of your right to elect
COBRA continuation coverage. If you have any questions or need assistance with enrollment, please call 800-570-1863.
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COBRA continuation coverage
If medical, dental, or vision coverage under the Plan ends
for you or your eligible dependents, you and/or your eligible
dependents may be able to continue your coverage under
the Plan’s continuation coverage provisions, which comply
with the Consolidated Omnibus Budget Reconciliation Act
of 1985, as amended (COBRA).
An event that makes you and/or your eligible dependents
eligible for COBRA continuation coverage is called a
“qualifying event,” such as termination of employment or
loss of benefits eligibility. Under COBRA, each person who
would lose coverage after a qualifying event is considered
a “qualified beneficiary.” Each qualified beneficiary has an
independent right to elect COBRA continuation coverage.
You must have had medical, dental, or vision coverage under
the Plan on the day before the date of your qualifying event
to be eligible for COBRA coverage, unless coverage ended
during a leave of absence, as described on this page. You may
choose a lesser coverage level or select an alternate medical
plan, if applicable. COBRA continuation coverage applies
to medical, dental, and vision coverage; it does not apply to
other benefits described in this Associate Benefits Book.
If you change medical plans when you elect COBRA
coverage, your annual deductible and out‑of‑pocket
maximum will reset, and you will be responsible for
meeting the new deductible and out‑of‑pocket maximum
in their entirety.
If you have HMO coverage at the time of your qualifying
event and the state where you live has more favorable
coverage continuation rules than federal COBRA, the HMO
generally follows state rules. For PPO Plan participants,
the PPO Plan also follows state rules. For information on
state continuation rights, contact your HMO provider or
the PPO Plan, as applicable.
IF YOU ARE ON LEAVE OF ABSENCE
Generally, if your leave ends and you do not return to work,
you and any eligible dependents who were enrolled in
medical, dental, or vision coverage under the Plan during
your leave will be offered COBRA, which will run from the
date following your employment termination date.
If you and any eligible dependents were enrolled in medical,
dental, or vision coverage under the Plan on the day before
your leave began but you dropped coverage during your
leave or your coverage was canceled due to nonpayment
of premiums during the leave, you will still be offered
COBRA when your employment terminates. If you elect
COBRA coverage, it will run from the date following your
employment termination date. This means that if you or any
eligible dependent elects COBRA at the end of a leave of
absence during which coverage was dropped or canceled,
the elected COBRA coverage will not be effective
retroactive to the date coverage was dropped or canceled,
but will be effective on the date following your employment
termination date.
COBRA qualifying events
You are eligible for COBRA if your medical, dental, or vision
coverage ends because:
• Your employment with Walmart ends for any reason, or
• You are no longer eligible for medical coverage because
the number of hours you regularly work for Walmart
has decreased, making you ineligible for coverage under
the Plan.
Your spouse or partner is eligible for COBRA if coverage for
the spouse or partner ends for any of the following reasons:
• Your employment with Walmart ends for any reason
• Your spouse or partner is no longer eligible for medical,
dental, or vision coverage because the number of hours
you regularly work for Walmart has decreased, making
them ineligible for coverage under the Plan
• You and your spouse divorce or legally separate
• You and your partner no longer meet the definition of
having a “partnership” for purposes of the Plan (refer to
the Eligibility and enrollment chapter for the definition
of “partner”)
• You enroll in Medicare benefits Part D, causing your
medical coverage to terminate (you must contact People
Services by calling 800-421-1362 within 60 days of
enrolling in Medicare Part D), or
• You die.
Your eligible dependent other than a spouse or partner is
eligible for COBRA if coverage for the dependent ends for
any of the following reasons:
• Your employment with Walmart ends for any reason
• Your eligible dependent is no longer eligible for medical,
dental, or vision coverage because the number of hours
you regularly worked for Walmart has decreased, making
them ineligible for coverage under the Plan
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• You enroll in Medicare benefits Part D, causing your
medical coverage to terminate. (You or your eligible
dependent must contact People Services by calling
800-421-1362 within 60 days of enrolling in Medicare
Part D.)
• Your dependent child no longer meets eligibility
requirements (e.g., the end of the month in which a
dependent turns age 26), or
• You die.
NOTIFICATION
In general, Walmart will notify WageWorks, the Plan’s
third‑party administrator for COBRA, if you or your
dependents become eligible for COBRA continuation
coverage because of your death, termination of
employment, a reduction in hours of employment that
makes you ineligible for coverage under the Plan, or you
enroll in Medicare Part D. You or your dependent must
notify People Services if you enroll in Medicare Part D.
Walmart will generally make this notification to the COBRA
administrator within 30 days after the qualifying event.
Under the law, you or your eligible dependent is responsible
for notifying People Services of your divorce, legal
separation, termination of your relationship with a partner,
or a child’s loss of dependent status. This is in addition to
any online life event session you may have completed.
The notification must be made within 60 days after the
qualifying event (or the date on which coverage would end
because of the qualifying event, if later). You or your eligible
dependent can provide notice on behalf of yourself as well
as any eligible dependent affected by the qualifying event.
Provide notice of the qualifying event to People Services by
calling 800-421-1362 or writing to:
Walmart People Services
508 SW 8th Street
Bentonville, Arkansas 72716-3500
The notice must include the following information:
• Name and address of the covered associate
• Type of qualifying event
• Date of qualifying event
• Name of dependent losing coverage, and
• Address of the dependent losing coverage (if different
from the covered associate’s address).
If you do not contact People Services within the 60‑day
period, you will lose your right to elect COBRA continuation
coverage. To protect your family’s rights, let People
Services know about any changes in addresses of family
members. You should keep a copy of any notices you send
to People Services and/or WageWorks for your records.
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Federal law places responsibility upon you
or your eligible dependent to notify People
Services within 60 calendar days after the
later of the date of a divorce, legal separation,
termination of your relationship with a
partner, or a child becoming ineligible due
to loss of dependent status, or the date on
which coverage under the Plan is terminated
as a result of one of these events. If you or
your eligible dependent do not notify People
Services within 60 days, your dependent will
not be eligible for COBRA.
You or your eligible dependent must also
notify the COBRA administrator by phone
or in writing of a second qualifying event or
Social Security disability in order to extend
the period of COBRA coverage. Other forms
of notice will not bind the Plan. If notice is not
provided by phone or in writing of a second
qualifying event or extension request within
60 days from the later of the date of the
second qualifying event or the date on which
you lost (or will lose) coverage as a result of a
second qualifying event, COBRA continuation
rights will expire on the date that your or your
eligible dependent’s initial COBRA coverage
period expires.
COBRA ENROLLMENT
Within 14 days after the COBRA administrator receives
notification that a qualifying event has occurred, the
COBRA administrator, on behalf of the Plan, will send
a COBRA election notice to you and your eligible
dependent at your last known address. The election
notice describes your right to continue medical, dental,
or vision coverage under COBRA. (If you do not receive
this notification, please contact People Services.) To
receive COBRA continuation coverage, you must elect
such coverage through the COBRA administrator within
60 calendar days from the date you lose coverage or the
date of the election notice, if later. To enroll, you must
complete and mail your COBRA election notice or go
online at mybenefits.wageworks.com. If you elect COBRA,
notify the COBRA administrator of any change of address.
Refer to Paying for COBRA coverage on the next page
for information on making COBRA payments. If you need
assistance, call 800-570-1863.
NOTE: You may be asked to provide documentation of the
qualifying event.
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You and each of your eligible dependents have independent
election rights. You may elect COBRA coverage for all
of your family members who lose coverage because of
the qualifying event. A parent or legal guardian may elect
COBRA coverage on behalf of a minor eligible dependent.
A child born to or placed for adoption with you while you
are on COBRA also has COBRA rights.
COBRA is provided subject to the eligibility requirements
for continuation coverage for you and your eligible
dependents under the law and the terms of the Plan. To
the extent permitted by law, the Plan Administrator will
retroactively terminate your COBRA coverage if you are
later determined to be ineligible.
will be responsible for meeting the new deductible and
out‑of‑pocket maximum in their entirety. If you change
from the Contribution Plan to another plan, your HRA
balance under the Contribution Plan will be forfeited.
If you are covered as a dependent and you experience a
qualifying event that affects your status as a dependent
and makes you eligible for your own continuation
coverage under COBRA, you will receive credit toward
your deductible and out‑of‑pocket maximum under
the Associates’ Medical Plan for expenses incurred as a
covered dependent, unless you change plan options as
described above. You will also receive credit toward any
waiting periods.
Instead of electing COBRA coverage, there
may be other coverage options for you and
your family through the Health Insurance
Marketplace or Medicaid. You may also be
eligible for a 30‑day “special enrollment period”
in another group health plan for which you are
otherwise eligible (such as a plan sponsored by
your spouse’s employer). You may also have the
same special enrollment right at the end of your
COBRA coverage if you take COBRA coverage
for the maximum time available to you. Some
of these options may cost less than COBRA
continuation coverage. You can learn more
about your options at healthcare.gov.
STATUS CHANGE EVENTS WHILE ON COBRA
CONTINUATION COVERAGE
After the COBRA election period, you or your eligible
dependent may not change the elected COBRA coverage
without a status change event outside Annual Enrollment
or a subsequent qualifying event. For information about
status change events, see Status change events in the
Eligibility and enrollment chapter. If a status change
event occurs (such as if a child is born), you must notify
the COBRA administrator within 60 calendar days of the
event. Supporting documentation may be required. You
will have the right to make changes to your coverage
during any Annual Enrollment while you are on COBRA.
Unless otherwise provided in the Plan, if you add a spouse or
partner or other eligible dependent due to a status change
event while on COBRA, each person must individually
meet any applicable benefit waiting period (for example,
for transplant coverage or weight loss surgery) and is
subject to any applicable Plan limitations. If you change
medical plans due to a status change event, your annual
deductible and out‑of‑pocket maximum will reset, and you
In the event of a status change, you or your eligible
dependent may change benefit coverage to another
benefit tier under the Plan only if the change in coverage is
consistent with the status change event.
If you move to a new location and this affects your medical
coverage (i.e., moving from an HMO area to a non‑HMO
area), you will have 60 calendar days from the date you
notify the COBRA administrator of the address change to
select a different plan. If you do not submit your selections
within 60 days, you may automatically be enrolled in a
predetermined plan.
Paying for COBRA coverage
You and/or your eligible dependents are responsible for
both the associate portion of the premium and the portion
previously paid by the company, plus a 2% administrative fee
(50% administrative fee in cases of the 11‑month disability
extension, as described later in this chapter). The letter sent
to you and your eligible dependents following notice of a
qualifying event will include the monthly premium cost for
COBRA coverage.
Initial COBRA premium: Your first payment is due 45 days
after you elect COBRA and must cover the cost of COBRA
coverage from the day following the qualifying event through
the end of the month before the month in which you make
your first payment. (For example, assume your employment
terminates on September 30, and you lose coverage on
September 30. You elect COBRA on November 15. Your initial
premium payment should equal the premiums for October
and November and is due on or before December 30, which is
the 45th day after the date of your COBRA election. Ongoing
premiums are due the first day of each month, with a 30‑day
grace period. So your December payment must be received
no later than December 31, the end of the 30‑day grace
period for the December coverage period.)
If your initial premium payment is not made in the allowed
time frame, you will not be eligible for COBRA coverage.
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Continuing premiums: Monthly premiums are due on the
first day of each month following the due date of the initial
premium. If you make your payment on or before the first
day of each month, your COBRA coverage under the Plan
will continue for that month without any break.
You are allowed a 30‑day grace period from the premium
due date before coverage is canceled. However, if you
make your payment later than the first day of the month,
your coverage will be suspended and any claims incurred,
including pharmacy benefits, will not be paid until coverage
is paid through the current month. If you do not pay this
premium, you will be responsible for claims incurred. If
the 30th day falls on a weekend or holiday, you have until
the first business day following to have your payment
postmarked or paid.
As a courtesy, the COBRA administrator will send you a
COBRA premium payment invoice, unless you make your
payments by Automated Clearing House (ACH) debit,
in which case you will not receive an invoice. Premium
payments are due regardless of your receipt of a payment
invoice. If you pay by mail, attach your payment to the
invoice and mail it to:
WageWorks
P.O. Box 660212
Dallas, Texas 75266-0212
To pay online, log on to mybenefits.wageworks.com. To pay
by phone, call 800-570-1863.
MAXIMUM DURATION OF COBRA COVERAGE
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If your COBRA coverage is canceled due to nonpayment of
premiums, your COBRA coverage will end on the last day
for which you paid your full COBRA premium on time, and it
will not be reinstated.
COBRA is month‑to‑month coverage and if you do not
want to continue coverage it can be terminated in the
following ways:
• Simply stop paying premiums and your COBRA coverage
will be terminated for nonpayment.
• Enter a support request in the WageWorks online
message center.
• Send a letter to WageWorks requesting termination of
your COBRA coverage, mailed to:
WageWorks
P.O. Box 226101
Dallas, Texas 75222-6101
If you choose to cancel coverage, it cannot be reinstated.
Coverage will be automatically canceled if your payment
is not postmarked on or before the deadline date of the
month your premium is due.
How long COBRA coverage may last
The maximum duration of your COBRA coverage depends
on the qualifying event making you eligible for COBRA
coverage, as shown in the chart below.
Event
Associate
Dependents
• Your employment with the company ends
18 months from the date of the event
18 months from the date of the event
for any reason
• You are no longer eligible for coverage
under the Plan due to a reduction in hours
• Your death
• Your marital
(or partnership) status changes
• Dependent no longer meets eligibility
requirements
(e.g., turns age 26)
You enroll in Medicare less than 18 months
prior to your termination of employment or
reduction in hours
Not applicable
36 months from the date of the event
18 months from the date of termination
of employment or reduction in hours
Up to 36 months from the date the
associate enrolled in Medicare
You enroll in Medicare Part D
Not applicable
36 months from the date the associate
enrolled in Medicare Part D
Disability extension is obtained
29 months from the date of the original
qualifying event
29 months from the date of the original
qualifying event
Second qualifying event — you must notify
the COBRA administrator within 60 days of
the second qualifying event or the date of
loss of coverage, if later
Not applicable
Up to 36 months from the date of the
original qualifying event
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IF YOU ARE ENTITLED TO MEDICARE
If you are eligible for Medicare Parts A and/or B and
terminate employment with the company (or lose coverage
under the Plan), be aware that if you do not enroll in Medicare
Parts A and/or B during the Medicare special enrollment
period, you may have to wait until the next Medicare annual
enrollment period to enroll in Medicare Parts A and/or
B and may have to pay a higher Medicare premium when
you do enroll. The eight‑month special enrollment period
runs from the date that you are no longer employed by
the company (or lose coverage under the Plan, whichever
occurs first), even if you elect COBRA continuation coverage
(e.g., following termination of employment). For additional
information, refer to Medicare’s Medicare & You handbook,
published annually. The handbook can be obtained directly
from Medicare by calling 800-633-4227 or from the
Medicare website at medicare.gov.
Entitlement to Medicare means you are eligible for and
enrolled in Medicare. If you become entitled to Medicare
less than 18 months before a qualifying event due to
termination of employment or reduction in hours, your
eligible dependents can elect COBRA for a period of not
more than 36 months from the date you became eligible
for Medicare.
If you are entitled to Medicare prior to your COBRA
election date, you or your eligible dependents must
notify the COBRA administrator at 800-570-1863 of your
Medicare status in order to ensure your maximum coverage
period is properly calculated.
IF YOU OR AN ELIGIBLE DEPENDENT
IS DISABLED
If you’re a qualified beneficiary who has COBRA coverage
because of termination of employment or reduction in
hours, you and each enrolled member of your family may
be entitled to an extra 11 months of COBRA coverage if
you or other enrolled members of your family become
disabled. (That is, you can get up to a total of 29 months of
COBRA coverage.) The 29‑month COBRA coverage period
begins on the date after your termination of employment or
reduction in hours of employment that makes you ineligible
for coverage under the Plan. The disability extension applies
only if all of the following conditions are met:
• The Social Security Administration determines that you or
your eligible dependent is disabled
• The disability exists at any time within the first 60 calendar
days of COBRA coverage and lasts at least until the end of
the 18‑month period of COBRA continuation coverage, and
• You and/or your eligible dependent notifies the COBRA
administrator of the Social Security Administration’s
disability determination by submitting a copy of the Social
Security Administration disability determination Notice
of Award letter to the COBRA administrator within your
initial 18‑month COBRA period.
In the absence of an official Notice of Award from Social
Security, the Plan may accept other correspondence from
the Social Security Administration if that correspondence
explicitly includes all information the Plan needs to grant
the extension and is submitted to the COBRA administrator
within the time frames listed above.
If you and/or your eligible dependent qualify for the
disability extension, a new invoice will be mailed to you
and/or your eligible dependent before the end of the initial
18‑month COBRA coverage period, unless you make your
payments by Automated Clearing House (ACH) debit, in
which case you will not receive an invoice. Contact the
COBRA administrator for details about paying premiums
during a disability extension.
The COBRA premium for the 19th through the 29th month
of COBRA coverage generally is the amount you were
paying before the qualifying event, plus the amount the
company was paying, plus a 50% administrative fee, or 150%
of the full premium amount.
However, if the disability extension applies, but the disabled
qualified beneficiary family member is not enrolled in
COBRA coverage, the COBRA premium for the covered
family members for the extended period is limited to 102%
of the full premium amount. You or your eligible dependent
must notify the COBRA administrator no later than 30 days
after the Social Security Administration determines that
you or your eligible dependent is no longer disabled.
IF YOU HAVE A SECOND QUALIFYING EVENT
WHILE ON COBRA
While you (the associate) cannot receive an extension of
COBRA coverage due to a second qualifying event, your
eligible dependent who has COBRA coverage due to your
termination of employment or reduction in hours may
receive COBRA coverage for up to a total of 36 months if a
second qualifying event occurs during the original 18‑month
continuation coverage period (or during the 29‑month
coverage period, in the event of a disability extension).
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The following can be second qualifying events:
• You or your eligible dependent becomes covered by
another group health, dental, or vision plan after electing
COBRA coverage
• During a disability extension period, the disabled
qualified beneficiary is determined by the Social Security
Administration to be no longer disabled (COBRA coverage
for all qualified beneficiaries, not just the disabled qualified
beneficiary, terminates as of the later of (a) the first
day of the month that is more than 30 days after a final
determination by the Social Security Administration that
the qualified beneficiary is no longer disabled, or (b) the
end of the coverage period that applies without regard to
the disability extension), or
• You or your eligible dependent submits a fraudulent claim
or fraudulent information to the Plan.
FILING AN APPEAL
You have the right to appeal an enrollment or eligibility
status decision related to your COBRA coverage. See
Appealing an enrollment or eligibility status decision in the
Claims and appeals chapter for more information.
• Your death
• Your divorce, legal separation, or termination of a
relationship with a partner
• Your child is no longer eligible for medical, dental, or vision
coverage (e.g., a dependent turns age 26), or
• Your enrollment in Medicare Part D.
If a second qualifying event occurs while your eligible
dependent has COBRA coverage, their COBRA coverage
may last up to 36 months from the date of the first
qualifying event that made you (the associate) eligible for
COBRA coverage.
To receive the extension of the COBRA
coverage period, you or your eligible
dependents must notify the COBRA
administrator of the second qualifying event
within 60 calendar days of the date of the
event or loss of coverage following the event,
if later. If the COBRA administrator is not
notified of the second qualifying event during
the 60‑day period, your eligible dependents
cannot get the COBRA coverage extension
and the coverage will be terminated as of the
date your initial COBRA period expired.
When COBRA coverage ends
COBRA coverage usually ends after the 18‑month,
29‑month, or 36‑month maximum COBRA coverage
period. See How long COBRA coverage may last in this
chapter to find out which maximum COBRA coverage
period applies to you.
COBRA coverage may be terminated before the end of the
18th, 29th, or 36th month if:
• The company no longer provides medical, dental, or vision
coverage to any associates
• After the initial 45‑day payment period you do not make a
COBRA payment within 30 calendar days of the due date
(if the 30th day falls on a weekend or non‑postal delivery
day, you have until the next business day to have your
payment postmarked or paid)
Resources for Living®
Using Resources for Living (RFL)
RFL counseling services
RFL legal and financial services
RFL daily life assistance
When RFL benefits end
Filing a claim for RFL benefits
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Resources for Living®
Resources for Living (RFL) gives you confidential counseling and well‑being information. It’s
available at no cost to you and your family members from your date of hire. Call a professional
counselor anytime for help with stress management, family relationships, career issues, and other
daily challenges. RFL also has lots of information and help with childcare, eldercare, education,
finances, wellness, and more.
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RESOURCES
Find What You Need
Online
Speak with a counselor or work‑life specialist
to identify resources and solutions for
everyday needs
Access articles, tools, and resources across a
wide range of topics
Access monthly healthy living tips and
webinars on a variety of topics
Go to One.Walmart.com or rfl.com:
User ID: Walmart
Password: Associate
Go to One.Walmart.com or rfl.com:
User ID: Walmart
Password: Associate
Other Resources
Call 800-825-3555
What you need to know about Resources for Living
• RFL is available 24 hours a day, seven days a week, 365 days a year.
• You and your household members can find counseling, information, and work‑life assistance.
• There is no cost to you for RFL benefits. You are automatically enrolled in RFL as of your date of hire.
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Using Resources for Living (RFL)
If you are a U.S. associate, you, your household family
members, and your benefit‑eligible dependents are
automatically enrolled in RFL as of your first day of
employment. You can call RFL any time at 800-825-3555
or log into rfl.com to find tools for:
• Stress management
• Budgeting and saving money
• Legal assistance
• Relationships at home and in the workplace
• Emotional and physical well‑being
• Family life and more
RFL provides access to services and support by telephone,
televideo, face‑to‑face and chat‑based counseling, videos,
webinars, web‑based articles, and through a resource team
that can help support your everyday needs and well‑being.
RFL counseling services
Whether you need help working through an issue or just
someone to talk to, RFL offers you 24/7/365 telephone
counseling support for a variety of common questions and
stressors. You can call and get help with:
• Managing stress
• Coping with depression, anxiety, or substance misuse
• Building healthy relationships with family, friends,
and co‑workers
• Balancing the demands of work and home life
• Working through emotionally difficult situations
In addition to unlimited in‑the‑moment telephone
counseling, you and your eligible family members may
receive up to 10 face‑to‑face or televideo counseling
sessions per person, per issue, per year, with an RFL
licensed therapist, or via app‑based chat through Talkspace,
at no cost to you. If your situation calls for therapeutic
counseling and you elect to use the Talkspace chat‑based
counseling, the 10 sessions equate to 10 weeks of chat
support per person, per issue, per year. Call RFL toll‑free
at 800-825-3555 for support and to learn more about
therapeutic counseling.
RFL legal and financial services
RFL gives you access to legal and financial experts. Whether
you’re creating a budget or a will, RFL can help you:
• Meet your financial goals and save for the future
• Explore your options related to legal issues
• Create a personal budget
• Make your money go further
• Pay down debt
• Recover from identify theft, and more
You can receive a half‑hour consultation for each legal
or financial issue or a one‑hour consultation for each
identity‑theft issue, at no cost to you. Note that this
service does not provide assistance in situations involving
employment law.
RFL daily life assistance
You can reach out to RFL for help in meeting the demands
of work and home life. Call for help with everyday needs
such as:
• Care for your child or an older adult
• Military resources
• Pet care
• Adoption resources
• Home repair services
• Support groups
• Educational options and resources for children and adults
• Accessing tools to support your well‑being, including
healthy eating, exercise, improved sleep, and stress
management
RFL’s work‑life consultants can help you find options for
meeting your needs and research details like cost, services,
and availability.
CALLING RFL
Call 800-825-3555 for personalized support at any
time. Services are available in English and Spanish (other
languages available upon request). Calls are confidential,
except as required by law.
RFL ON THE WEB
Visit rfl.com for articles, webinars, tools, and resources on
a variety of topics to help you live well. To log on to rfl.com,
enter the following:
User ID: Walmart
Password: Associate
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You can also access rfl.com by clicking on the single sign‑on
link found on the RFL page of One.Walmart.com.
When RFL benefits end
If you experience a qualifying event and become eligible
for COBRA benefits, your Resources for Living benefits
automatically continue for 18 months from the date of the
qualifying event (or the maximum duration for which you
would be eligible for COBRA coverage). You do not have to
enroll in COBRA coverage to continue your Resources for
Living benefits.
Filing a claim for RFL benefits
You do not have to file a claim for RFL benefits. You may
access the RFL website or contact RFL by phone at any
time. However, if you have a question about your benefits,
or disagree with the benefits provided, you may contact
People Services at 800-421-1362 or file a claim by writing to
the following address:
People Services
508 SW 8th Street
Bentonville, Arkansas 72716-3500
Claims and appeals are determined under the time frames
and requirements set out in the procedures for filing a
claim for medical benefits, as described in the Claims and
appeals chapter.
Critical illness
insurance
Critical illness insurance
Critical illness benefits
When your critical illness insurance coverage begins
Naming a beneficiary
Filing a claim
When benefits are not paid
Break in coverage
When coverage ends
If you leave the company and are rehired
If you drop coverage and reenroll
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This information is intended to be a summary of your benefits and may not include all policy provisions.
If there is a discrepancy between this document and the policy issued by Allstate Benefits regarding the
calculation of benefits and limitations under the policy, the terms of the policy will govern. You may obtain a
copy of this policy by contacting the Plan. Allstate Benefits is the marketing name used by American Heritage
Life Insurance Company, the underwriting company and subsidiary of The Allstate Corporation.
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Critical illness insurance
If you and your dependents sign up for critical illness insurance, you’ll be eligible for a direct
lump‑sum cash benefit to help pay for expenses related to covered critical illnesses.
RESOURCES
Find What You Need
Online
Other Resources
Get detailed information
Go to One.Walmart.com or
AllstateBenefits.com/Walmart
Call Allstate Benefits at 800-514-9525
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What you need to know about critical illness insurance
• You may purchase critical illness insurance to assist you and your family in the event a covered individual is diagnosed
with certain serious illnesses.
• You may elect coverage amounts of $5,000, $10,000, $15,000, or $20,000.
• If a covered individual is diagnosed with a covered condition, critical illness insurance pays a percentage of the
coverage amount in a lump sum, based on the nature of the condition.
• Proof of Good Health is not required for any level of coverage.
• The Certificate of Insurance available online at One.Walmart.com or AllstateBenefits.com/Walmart provides detailed
information about critical illness insurance, in addition to the highlights available in this chapter.
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Critical illness insurance
Critical illness insurance provides a direct benefit if you
or any covered dependents are diagnosed with a covered
illness or disease. The policy pays benefits regardless of,
and in addition to, any other insurance you may have.
Coverage is available in $5,000 increments up to a maximum
of $20,000 with no Proof of Good Health required.
Critical illness insurance is available to you if you are an
hourly or management associate. Coverage is also available
to your dependents, with the exception of spouses/partners
of part‑time associates, temporary associates, and part‑time
truck drivers.
CHOOSING A COVERAGE LEVEL
When you enroll for critical illness insurance, you also
select the eligible family members you wish to cover:
• Associate only
• Associate + spouse/partner (except for part‑time
hourly associates, temporary associates, and part‑time
truck drivers)
• Associate + child(ren), or
• Associate + family (except for part‑time hourly associates,
temporary associates, and part‑time truck drivers).
For information on eligibility and when you can enroll, see
the Eligibility and enrollment chapter.
The cost for coverage is based on the coverage amounts
you choose, the eligible dependents you choose to cover,
your age, and whether you (and/or your covered spouse/
partner) are eligible for tobacco‑free rates.
If you have associate‑only or associate + spouse/partner
coverage and you (or your spouse/partner) give birth to
a child, your newborn child will be automatically covered
for 60 days after birth. You must change your election
to associate + child(ren) or associate + family if you wish
to continue covering your child after 60 days. See the
Eligibility and enrollment chapter for information on when
and how you may change your election.
Critical illness benefits
Benefits are payable if you are diagnosed with one of the
conditions listed below. Coverage must be effective before
the date of diagnosis for an illness or disease to be covered
under the policy.
The following benefits are payable at 100% of the coverage
amount you elect:
• Invasive cancer
• Alzheimer’s disease (requires loss of three activities of daily
living [ADLs])
• Coronary artery bypass surgery
• End‑stage renal failure
• Heart attack
• Stroke
• Parkinson’s disease (requires loss of two ADLs)
• Complete loss of hearing (due to illness)
• Loss of sight in one eye or both eyes (due to illness)
• Quadriplegia (due to illness)
• Paraplegia (due to illness)
• Loss of at least one foot, hand, arm, or leg (due to illness)
• Benign brain tumor
• Coma (lasting seven days) due to illness
• Sickle cell anemia
• Systemic lupus
• Tuberculosis, or
• Major organ transplant (see note below).
If you undergo a major organ transplant, as specified in the
major organ transplant rider found in the Certificate of
Insurance, you will receive 100% of the coverage amount
you elect. If you are enrolled in the Saver Plan, you are not
eligible for the major organ transplant rider included in
critical illness insurance.
The following benefits are payable at less than 100% of the
coverage amount you elect:
• Carcinoma in situ: 25% of coverage amount
• Complete loss of one or more fingers and/or one or more
toes (due to illness): 25% of coverage amount
• Transient ischemic attacks (TIAs): 25% of coverage amount
• Aneurysm (ruptured or dissecting): 25% of coverage amount
• Specified diseases: 50% of coverage amount
– Addison’s disease
– Amyotrophic lateral sclerosis (Lou Gehrig’s disease)
– Cerebrospinal meningitis (bacterial)
– Cerebral palsy
– Cystic fibrosis
– Diphtheria
– Encephalitis
– Huntington’s chorea
– Legionnaires’ disease (confirmation by culture or sputum)
– Malaria
– Multiple sclerosis
– Muscular dystrophy
– Myasthenia gravis
– Necrotizing fasciitis
– Osteomyelitis
– Poliomyelitis
– Rabies
– Systemic sclerosis (scleroderma), or
– Tetanus.
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The benefits described above generally will be paid only
once, upon the initial occurrence of each critical illness
identified above (or, in the instance of invasive cancer,
for the particular form of cancer). However, if you have a
recurrence of heart attack, stroke, coronary artery bypass
surgery, invasive cancer, carcinoma in situ, rabies, ruptured
or dissecting aneurysm, benign brain tumor, or coma, the
plan will pay a recurrence benefit of 100% of the coverage
amount, provided the recurrence occurs 180 days after the
prior occurrence (or, in the case of a recurrence of the same
cancer, provided you were symptom‑free and treatment‑free
during the 180 days after the prior occurrence).
Other benefits payable include:
• Ambulance: $400 for ground ambulance or $4,000 for
air ambulance if a covered person requires ambulance
transportation to a hospital or emergency center due to
a covered illness.
• Post‑traumatic stress disorder (PTSD): $100 for each day
a covered person receives counseling for PTSD; payable
once per day per covered person and limited to six days
per calendar year
• Skin cancer benefit: $500 upon positive diagnosis of
skin cancer (basal cell carcinoma and squamous cell
carcinoma) by a licensed Doctor of Medicine certified
by the American Board of Pathology to practice
pathological anatomy, or an osteopathic pathologist,
based on microscopic examination of skin biopsy samples.
This benefit is not paid for malignant melanoma (which is
covered under the invasive cancer benefit). It also does
not include any conditions which may be considered
precancerous, such as: leukoplakia; actinic keratosis;
carcinoid; hyperplasia; polycythemia; nonmalignant
melanoma; moles; or similar diseases or lesions. Payable
only once per covered person each calendar year.
• National Cancer Institute (NCI) evaluation and Walmart
Centers of Excellence evaluation: when evaluated for
determining the appropriate treatment of a previously
diagnosed covered illness, $500 for evaluation; $250 for
transportation and lodging if the center is more than
100 miles from your home. Payable once for each initial
occurrence or recurrence of a covered illness.
• Lodging benefit: $60 per day when you or a covered
family member receive treatment for a covered illness on
an outpatient basis at a treatment facility more than 100
miles from your or your covered family member’s home.
This benefit is limited to 60 days per calendar year and
is not payable for lodging occurring more than 24 hours
prior to treatment or for lodging occurring more than 24
hours following treatment.
• Transportation benefit: $0.50 per mile for personal vehicle,
up to $1,500, or up to $1,500 round‑trip transportation
for coach fare on a common carrier. Transportation must
be required for treatment of a covered critical illness at a
hospital (inpatient or outpatient), radiation therapy center,
chemotherapy or oncology clinic, or any other specialized
freestanding treatment facility. If the treatment is for a
covered child and common carrier travel is necessary, the
benefit will be paid for up to two adults to accompany the
child. This benefit will not be paid if the covered person
lives within 100 miles of the treatment facility.
Your Certificate of Insurance will contain complete
information on the benefits payable. To obtain a copy, visit
One.Walmart.com or AllstateBenefits.com/Walmart. You
can also call Allstate Benefits at 800-514-9525 for a copy.
When your critical illness insurance
coverage begins
If you enroll during Annual Enrollment, your coverage
becomes effective on January 1 of the next year.
If you enroll outside of Annual Enrollment, your coverage
becomes effective on the date of your status change event
or the end of your eligibility waiting period, whichever is
later. No benefit is payable for any disease diagnosed before
your effective date of coverage. If you should die before
your effective date, no critical illness insurance benefit will
be paid to your beneficiary(ies).
Your critical illness insurance begins whether or not you are
actively at work, as long as you have reported for your first
day of work and enrolled for the benefit. See the Eligibility
and enrollment chapter for details.
Naming a beneficiary
If you die while covered under critical illness insurance, your
beneficiary(ies) will receive any benefits due at the time of
your death.
You must name a beneficiary(ies) to receive your critical
illness insurance benefit if you die. Do this by going to
One.Walmart.com. Note that only beneficiary designations
made online are accepted.
You can name anyone you wish. If the beneficiary(ies) you
list with Walmart differs from the beneficiary(ies) named in
your will, the list that Walmart has prevails.
The following information is needed for each beneficiary
you name:
• Name
• Current address and phone number
• Relationship to you
• Social Security number
• Date of birth, and
• The percentage you wish to designate per beneficiary,
up to 100%.
If two or more beneficiaries are designated and their shares
are not specified, they will share the insurance benefit equally.
If a named beneficiary dies before you, that beneficiary’s
interest will end, and will be shared equally by any remaining
beneficiaries unless your beneficiary form states otherwise.
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You can name a minor as a beneficiary; however, Allstate
Benefits may not be legally permitted to pay the minor
until the minor reaches legal age. You may want to consult
an attorney or an estate planner before naming a minor as
a beneficiary.
You (the associate) are automatically assigned as the primary
beneficiary of your dependent’s critical illness coverage. If
you and your dependent die at the same time, benefits will
be paid to your dependent’s estate or at Allstate Benefits’
option to a surviving relative of the dependent.
CHANGING YOUR BENEFICIARY
Be sure to provide the following information for the
covered person:
• Name
• Social Security number, and
• Date the covered illness began.
You may request a claim form from Allstate Benefits or
visit One.Walmart.com or AllstateBenefits.com/Walmart
to obtain a copy. If you do not receive a claim form within
15 days of your request, you may send a notice of the claim
to Allstate Benefits by providing Allstate Benefits with a
statement of the nature and extent of the loss.
You can change your beneficiary(ies) at any time on
One.Walmart.com. Any change in beneficiary must be
completed and submitted to Walmart before your death and
can be submitted only by you, the covered associate.
Claims are determined under the time frames and
requirements set out in the Claims and appeals chapter.
You or your beneficiary has the right to appeal a claim
denial. See the Claims and appeals chapter for details.
IF YOU DO NOT NAME A BENEFICIARY
If no beneficiary is named or there is no surviving
beneficiary at the time of your death, payment will be made
to your surviving family member(s) in the following order:
1. Your spouse/partner; if not surviving, then
2. Your children, in equal shares; if not surviving, then
3. Your parents, in equal shares; if not surviving, then
4. Your siblings, in equal shares; if not surviving, then
5. Your estate.
Be sure to keep your beneficiary information
up to date. Proceeds go to whoever is listed
on your beneficiary form with Walmart,
regardless of your current relationship with
that person, unless state law says otherwise.
You can change your beneficiary(ies) at any
time on One.Walmart.com.
Filing a claim
Within 60 days of the occurrence or commencement of any
covered critical illness, or as soon as reasonably possible,
send a notice of claim to:
Allstate Benefits
Attn: Walmart Claims Unit
P.O. Box 41488
Jacksonville, Florida 32203-1488
You may also provide notice of claim as follows:
Online: AllstateBenefits.com/mybenefits
By phone: 800-514-9525
By fax: 877-423-8804
When benefits are not paid
This policy does not pay benefits for any critical illness due
to or resulting directly or indirectly from:
• Any act of war, whether or not declared, or participation in
a riot, insurrection, or rebellion
• Intentionally self‑inflicted injuries
• Engaging in an illegal occupation or committing or
attempting to commit a felony
• Attempted suicide, while sane or insane
• Being under the influence of narcotics or any other
controlled chemical substance, unless administered upon
the advice of a physician
• Participation in any form of aeronautics, except as a
fare‑paying passenger in a licensed aircraft provided
by a common carrier and operating between definitely
established airports, or
• Alcohol abuse or alcoholism, drug addiction, or
dependence upon any controlled substance.
Break in coverage
There may be occasions in which you must make special
arrangements to pay your critical illness insurance
premiums to avoid a break in coverage. These situations
occur most commonly if you are on a leave of absence or
if your Walmart paycheck is not sufficient to pay your full
share of the cost of coverage (such as after a reduction in
hours). Failure to make your premium payments by the due
date may result in an interruption in the payment of any
benefit claims and/or a break in coverage.
For details on the impact a break in coverage may have,
and on how to make personal payments to continue your
coverage, see When special arrangements are necessary to
maintain coverage in the Eligibility and enrollment chapter.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
IF YOU GO ON A LEAVE OF ABSENCE
You may continue your coverage up to the last day of an
approved leave of absence, provided that you pay your
premiums before or during the leave. For information
about making payments while on a leave of absence, see
When special arrangements are necessary to maintain
coverage in the Eligibility and enrollment chapter.
The premiums for portability coverage are due in advance
of each month’s coverage, on the first day of the calendar
month. The premiums are set at the same rate in effect
under critical illness insurance for active associates with
the same coverage.
For more information, please contact Allstate Benefits at
800-514-9525.
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When coverage ends
Your critical illness insurance coverage ends on the earliest
of the following:
• At termination of your employment
• On the last day of coverage for which premiums were
paid, if you fail to pay your premiums within 30 days of
the date your premium is due
• On your date of death
• On the last day of an approved leave of absence (unless
you return to work), or
• When the benefit is no longer offered by the company.
Critical illness insurance coverage for your spouse/
partner ends:
• On the date your insurance coverage ends
• On the last day of the pay period when your job status
changes to part‑time, temporary, or part‑time truck driver
• On the date your spouse/partner loses eligibility, such
as upon a valid decree of divorce or termination of
partnership, or
• On your spouse/partner’s death.
Critical illness insurance coverage for your dependent
child(ren) ends:
• On the date your insurance coverage ends
• On the date your dependent child loses eligibility, or
• On your dependent child’s death.
If you voluntarily drop coverage after a status change event
or at Annual Enrollment, coverage ends as follows:
• After a status change event: coverage ends on the
effective date of the event. See Status change events in
the Eligibility and enrollment chapter for information.
• At Annual Enrollment: coverage ends on December 31 of
the current year.
CONTINUATION OF COVERAGE
AT TERMINATION
If your coverage under critical illness insurance terminates as
described earlier in this section, you may continue to receive
critical illness insurance directly from Allstate Benefits
through portability coverage. To receive portability coverage,
you must notify Allstate Benefits that you wish to continue
coverage and send the first premium within 60 days of the
date your coverage under critical illness insurance terminates.
WHEN YOUR DEPENDENT BECOMES INELIGIBLE
Any eligible dependent covered under critical illness insurance
at the time such coverage terminates may also receive
portability coverage, under the terms described above.
Contact Allstate Benefits at 800-514-9525 for information.
If you leave the company
and are rehired
If you leave the company and then return to work within
13 weeks, you will automatically be reenrolled for the same
coverage plan you had prior to leaving the company (or the
most similar coverage offered under the Plan).
If your break is greater than 30 days but less than 13 weeks,
you will have 60 days after resuming work to drop or
otherwise change the coverage in which you were
automatically reenrolled.
If you return to work after 13 weeks, you will be considered
newly eligible and may enroll for coverage under the time
periods and conditions described in the Eligibility and
enrollment chapter.
If you drop coverage and reenroll
If you drop coverage and reenroll within 30 days, you will
automatically be reenrolled for the same coverage you had
prior to dropping coverage (or the most similar coverage
offered under the Plan).
If you drop coverage and reenroll after 30 days, you will be
considered newly eligible and may enroll for coverage under
the time periods and conditions described in the Eligibility
and enrollment chapter.
IF A DEPENDENT IS DROPPED FROM
COVERAGE AND REENROLLED
If your dependent child is dropped from coverage and then
determined to be eligible for coverage within 30 days, the
dependent will automatically be reenrolled in the same
coverage you elect for yourself.
If your dependent regains eligibility and is reenrolled after
30 days, they will be treated as a newly eligible dependent.
The associate may enroll them for coverage under the
time periods and conditions described in the Eligibility and
enrollment chapter.
Accident insurance
Accident insurance
Accident insurance benefits
When your accident insurance coverage begins
Naming a beneficiary
Filing a claim
When benefits are not paid
Break in coverage
When coverage ends
If you leave the company and are rehired
If you drop coverage and reenroll
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This information is intended to be a summary of your benefits and may not include all policy provisions.
If there is a discrepancy between this document and the policy issued by Allstate Benefits regarding the
calculation of benefits and limitations under the policy, the terms of the policy will govern. You may obtain a
copy of this policy by contacting the Plan. Allstate Benefits is the marketing name used by American Heritage
Life Insurance Company, the underwriting company and subsidiary of The Allstate Corporation.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Accident insurance
This insurance helps you if you’re in an accident away from work. If the accident is covered, this
can help you pay for things like immediate care treatment, hospitalization, physical therapy,
transportation, and lodging. Benefits are paid directly to you unless you want to have them paid to
the provider.
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RESOURCES
Find What You Need
Online
Other Resources
Get detailed information
Go to One.Walmart.com or
AllstateBenefits.com/Walmart
Call Allstate Benefits at 800-514-9525
What you need to know about accident insurance
• You may purchase accident insurance to assist you and your family if a covered individual has a covered accident
that requires medical care.
• Accident insurance pays a set benefit in a lump sum, based on the nature of the accident and the care required.
• Proof of Good Health is not required for any level of coverage.
• Coverage is provided through Allstate Benefits. The Certificate of Insurance available online at One.Walmart.com
or AllstateBenefits.com/Walmart provides detailed information about accident insurance, in addition to the
highlights available in this chapter.
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Accident insurance
Accident insurance provides benefits to you if you or any
covered dependent receives covered treatment related to
an off‑the‑job accident. The benefits under this policy are
not reduced by any other benefits you may receive.
Accident insurance is available to you if you are an hourly or
management associate. Coverage is also available to your
dependents, with the exception of spouses/partners of
part‑time associates, temporary associates, and part‑time
truck drivers.
CHOOSING A COVERAGE LEVEL
When you enroll for accident insurance, you also select
the eligible family members you wish to cover:
• Associate only
• Associate + spouse/partner (except for part‑time
hourly associates, temporary associates, and part‑time
truck drivers)
• Associate + child(ren), or
• Associate + family (except for part‑time hourly associates,
temporary associates, and part‑time truck drivers).
For information on eligibility and when you can enroll,
see the Eligibility and enrollment chapter.
The cost for coverage is based on the eligible dependents
you choose to cover.
If you have associate‑only or associate + spouse/partner
coverage and you (or your spouse/partner) give birth to
a child, your newborn child will be automatically covered
for 60 days after birth. You must change your election
to associate + child(ren) or associate + family if you wish
to continue covering your child after 60 days. See the
Eligibility and enrollment chapter for information on when
and how you may change your election.
Accident insurance benefits
Accident insurance provides benefits if you or a covered
dependent seeks medical treatment or is hospitalized as a
result of a covered accident that happens off the job. An
accident generally is a covered accident if it occurs while
you (or your covered family member) are not working at
any job for pay or benefits and is the result of a sudden,
unforeseen, and unexpected event that results in injury
and occurs without the injured person’s intent. Certain
accidents are not covered. See When benefits are not paid
later in this chapter for more information.
For a complete list of benefits and the amounts payable,
visit One.Walmart.com or AllstateBenefits.com/Walmart.
Accident insurance will pay a benefit if you receive particular
services in connection with a covered off‑the‑job accident.
See the chart on the next page for details regarding services
for which accident insurance pays a benefit.
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SERVICE
BENEFIT AMOUNT
LIMITATIONS
Immediate care (physician
fees, x‑rays, and emergency
department)
$170 per covered accident
Services must be received within 30 days of
covered accident.
Follow‑up treatment (not
covered under physical
therapy)
$50 per follow‑up treatment after
emergency treatment paid under
immediate care, up to 6 treatments
Follow‑up visits must occur within 30 days of the
initial covered treatment. Benefit paid for only one
treatment per day.
Physical therapy (not covered
by follow‑up treatment)
$50 per day, up to 10 days
Initial hospitalization
$1,500 payable the first time a covered
person is hospitalized for at least 24
hours; $2,250 if admitted directly to a
hospital intensive care unit
Therapy must begin within 30 days of covered
accident or discharge from hospital and be received
within six months of covered accident or discharge.
Hospitalization must begin within 30 days of
the covered accident. Payable only once per
hospitalization per calendar year.
Hospital confinement
Daily benefit of $300 for a continuous
hospital confinement for at least 18 hours,
up to 365 days
Hospitalization must begin within 30 days of
covered accident. Not payable on same day
rehabilitation benefit is paid.
Intensive care unit (ICU)
confinement
$900 per day, up to 15 days
Confinement must begin within 30 days of
covered accident.
Step‑down ICU confinement
$200 per day, up to 15 days
Rehabilitation unit confinement
(after hospitalization)
$100 per day confined to rehabilitation
unit
Must be confined to step‑down intensive care unit
for at least 18 hours.
Payable up to 30 days per continuous period of
confinement; maximum of 60 days. Not payable for
days in which hospital confinement benefit is paid.
Major diagnostic exams
$400 for CT scan, MRI, or EEG
One payment per calendar year.
Appliance to aid personal
locomotion or mobility
$200 for crutches, wheelchair, leg brace,
back brace, walker, and CAM boot walker
Payable once per covered accident.
Prosthesis
$1,000
Payable once per covered accident. Not payable
for hearing aids, wigs, or dental aids (including
false teeth).
Ambulance
$400 for ground ambulance or $4,000
for air ambulance
Transportation by ambulance must occur within 72
hours of covered accident.
Blood, plasma, and/or platelets
$100
Not payable for immunoglobulins. Payable once
per covered accident.
Transportation for treatment at
a non‑local hospital
$400 per round trip; additional $400 if
dependent child is receiving treatment
Payable for up to three roundtrips per year. Not
payable for ambulance transportation.
Family lodging for confinement
at a non‑local hospital
$100 per night for an immediate family
member of covered person, up to 30 days
Payable only during the days the covered person is
confined to the non‑local hospital.
Post‑traumatic stress disorder
$100 per day for PTSD counseling
Payable only once per day, up to six days per
calendar year.
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Accident insurance also pays a benefit if the following specific injuries are sustained in a covered accident:
INJURY
Dislocation
Burns
Skin grafts
Eye injury
Lacerations
Fractures
BENEFIT AMOUNT
LIMITATIONS
$188–$3,750, depending on joint dislocated Payable for up to two dislocations per accident.
Certain treatments may result in a lesser benefit.
$100–$10,000 depending on degree of
burn and size of affected area
If proof of loss does not specify size of burn, the
lowest benefit amount will be paid. Treatment by a
physician must occur within 72 hours of the covered
accident.
50% of benefit amount under burns
Paid in addition to the burn benefit.
$250 for surgical repair; $50 for removal of
foreign body
$25–$400, depending on the size of the
laceration
$375–$3,750, depending on location
of fracture; 25% for chip fractures or
other fractures not corrected by open or
closed repair
For services performed by a physician.
If proof of loss does not specify size of laceration, the
lowest benefit amount will be paid. Treatment must
occur within 72 hours of the covered accident.
For fractures corrected by open or closed repair as a
result of covered accident. Payable for no more than
two fractures per covered accident.
Concussions (brain)
$50
As a result of covered accident.
Emergency dental services
$50 for broken teeth extracted; $150 for
broken teeth repaired with crowns
Payable once per covered accident.
Coma
$10,000
Surgical procedures
$350–$1,400, depending on
surgical procedure
Coma must persist at least seven days. Medically
induced comas are excluded.
Must be performed within one year of covered
accident. Miscellaneous surgery is payable once per
24 hours even though more than one surgery or
procedure may be performed.
Your Certificate of Insurance will contain complete information on the benefits payable. To obtain a copy, visit One.Walmart.com
or AllstateBenefits.com/Walmart. You can also call Allstate Benefits at 800-514-9525 for a copy, which will be provided at no
cost to you.
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When your accident insurance
coverage begins
If you enroll during Annual Enrollment, your coverage
becomes effective on January 1 of the next Plan year.
You can name a minor as a beneficiary; however, Allstate
Benefits may not be legally permitted to pay the minor
until the minor reaches legal age. You may want to consult
an attorney or an estate planner before naming a minor
as a beneficiary.
If you enroll outside of Annual Enrollment, your coverage
becomes effective on the date of your status change
event or the end of your eligibility waiting period,
whichever is later. If you should die before your effective
date, no accident insurance benefit will be paid to your
beneficiary(ies).
Your accident insurance begins whether or not you are
actively at work, as long as you have reported for your first
day of work and enrolled for the benefit. See the Eligibility
and enrollment chapter for details.
Naming a beneficiary
If you die while covered under accident insurance, your
beneficiary(ies) will receive any benefits due at the time of
your death.
You must name a beneficiary(ies) to receive your accident
insurance benefit if you die. You may do this by going to
One.Walmart.com. Note that only beneficiary designations
made online are accepted.
You can name anyone you wish. If the beneficiary(ies) you
list with Walmart differs from the beneficiary(ies) named in
your will, the list that Walmart has prevails.
The following information is needed for each beneficiary:
• Name
• Current address and phone number
• Relationship to you
• Social Security number
• Date of birth, and
• The percentage you wish to designate per beneficiary,
up to 100%.
If two or more beneficiaries are designated and their
shares are not specified, they will share the insurance
benefit equally. If a named beneficiary dies before you, that
beneficiary’s interest will end, and will be shared equally by
any remaining beneficiaries unless your beneficiary form
states otherwise.
Be sure to keep your beneficiary information up to date.
Proceeds go to whoever is listed on your beneficiary form
on file with Walmart, regardless of your current relationship
with that person, unless state law requires otherwise.
You (the associate) are automatically assigned as the
primary beneficiary of your dependent’s accident coverage.
If you and your dependent die at the same time, benefits
will be paid to your dependent’s estate or at Allstate
Benefits’ option to a surviving relative of the dependent.
CHANGING YOUR BENEFICIARY
You can change your beneficiary(ies) at any time on
One.Walmart.com. Any change in beneficiary must be
completed and submitted to Walmart before your death and
can be submitted only by you, the covered associate.
IF YOU DO NOT NAME A BENEFICIARY
If no beneficiary is named or there is no surviving
beneficiary at the time of your death, payment will be made
to your surviving family member(s) in the following order:
1. Your spouse/partner; if not surviving, then
2. Children, in equal shares; if not surviving, then
3. Parents, in equal shares; if not surviving, then
4. Siblings, in equal shares; if not surviving, then
5. Your estate.
Be sure to keep your beneficiary information
up to date. Proceeds go to whoever is listed
on your beneficiary form with Walmart,
regardless of your current relationship with
that person, unless state law says otherwise.
You can change your beneficiary(ies) at any
time on One.Walmart.com.
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Filing a claim
Within 60 days of the occurrence or commencement of any
covered accident, or as soon as reasonably possible, send a
notice of claim to:
Allstate Benefits
Attn. Walmart Claims Unit
P.O. Box 41488
Jacksonville, Florida 32203-1488
• Suicide, or any attempt at suicide, whether sane or insane
• Any injury sustained while you or your covered family
member are under the influence of alcohol or any narcotic,
unless administered upon the advice of a physician
• Dental or plastic surgery for cosmetic purposes, except
when such surgery is required to treat an injury or correct
a disorder of normal bodily function that was caused by
an injury
• Committing or attempting to commit an assault or felony
You may also provide notice of claim as follows:
• Any injury incurred while a covered person is an active
Online: AllstateBenefits.com/mybenefits
By phone: 800-514-9525
By fax: 877-423-8804
Provide the following information for the covered person:
member of the military, naval, or air forces of any country
or combination of countries. Upon notice and proof of
service in such forces, Allstate Benefits will return the
prorated portion of the premium paid for any period of
such service.
• Name
• Social Security number, and
• Date the covered accident occurred.
You may request a claim form from Allstate Benefits or
visit One.Walmart.com or AllstateBenefits.com/Walmart
to obtain a copy. If you do not receive a claim form within
15 days of your request, you may send a notice of the claim
to Allstate Benefits by providing Allstate Benefits with a
statement of the nature and extent of the loss.
You will be required to provide written proof of your claim
to Allstate. Generally, you should provide written proof
related to your claim within 90 days of the service or loss,
or as soon as reasonably possible after the loss if it is not
possible to provide it within 90 days. In any event, you
generally must provide any required proof of the claim to
Allstate within 15 months, or your claim will be denied.
Claims are determined under the time frames and
requirements set out in the Claims and appeals chapter. You
or your beneficiary has the right to appeal a claim denial.
When benefits are not paid
Benefits are not paid for a loss that is caused by or occurs as
a result of:
• An injury that results from an accident that occurs while
working at any job for pay or benefits
• An injury incurred prior to your effective date of coverage
Break in coverage
There may be occasions in which you must make special
arrangements to pay your accident insurance premiums
to avoid a break in coverage. These situations occur most
commonly if you are on a leave of absence or if your
Walmart paycheck is not sufficient to pay your full share of
the cost of coverage (such as after a reduction in hours).
Failure to make your premium payments by the due date
may result in an interruption in the payment of any benefit
claims and/or a break in coverage.
For details on the impact a break in coverage may have,
and on how to make personal payments to continue your
coverage, see When special arrangements are necessary to
maintain coverage in the Eligibility and enrollment chapter.
IF YOU GO ON A LEAVE OF ABSENCE
You may continue your coverage up to the last day of an
approved leave of absence, provided that you pay your
premiums before or during the leave. For information about
making payments while on a leave of absence, see When
special arrangements are necessary to maintain coverage in
the Eligibility and enrollment chapter.
When coverage ends
Your accident insurance coverage ends on the earliest of
the following:
• Any act of war, whether or not declared, or participation in
• At termination of your employment
a riot, insurrection or rebellion
• On the last day of coverage for which premiums were paid,
if you fail to pay your premiums within 30 days of the date
your premium is due
• On your date of death
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• On the last day of an approved leave of absence (unless
WHEN YOUR DEPENDENT BECOMES INELIGIBLE
you return to work), or
• When the benefit is no longer offered by the company.
Accident insurance coverage for your spouse/partner ends:
• On the date your accident insurance coverage ends
• On the last day of the pay period when your job status
changes to part‑time, temporary, or part‑time truck driver
• On the date your spouse/partner loses eligibility, such
as upon a valid decree of divorce or termination of
partnership, or
• On your spouse/partner’s death.
Accident insurance coverage for your dependent
child(ren) ends:
• On the date your accident insurance coverage ends
• On the date your dependent child loses eligibility, or
• On your dependent child’s death.
If you voluntarily drop coverage after a status change event
or at Annual Enrollment, coverage ends as follows:
• After a status change event: coverage ends on the
effective date of the event. See Status change events in
the Eligibility and enrollment chapter for information.
• At Annual Enrollment: coverage ends on December 31 of
the current year.
CONTINUATION OF COVERAGE
AT TERMINATION
If your coverage under accident insurance terminates
as described earlier in this section, you may continue to
receive accident insurance directly from Allstate Benefits
through portability coverage. To receive portability
coverage, you must notify Allstate Benefits that you
wish to continue coverage and send the first premium
within 60 days of the date your coverage under accident
insurance terminated.
The premiums for portability coverage are due in advance
of each month’s coverage, on the first day of the calendar
month. The premiums are set at the same rate in effect
under accident insurance for active associates with the
same coverage.
For more information, please contact Allstate Benefits
at 800-514-9525.
Any eligible dependent covered under accident insurance
at the time such coverage terminated may also receive
portability coverage, under the terms described on the
previous page. Contact Allstate Benefits at 800-514-9525
for information.
If you leave the company and
are rehired
If you leave the company and then return to work within
13 weeks, you will automatically be reenrolled for the same
coverage plan you had prior to leaving the company (or the
most similar coverage offered under the Plan).
If your break is greater than 30 days but less than
13 weeks, you will have 60 days after resuming work to
drop or otherwise change the coverage in which you were
automatically reenrolled.
If you return to work after 13 weeks, you will be considered
newly eligible and may enroll for coverage under the time
periods and conditions described in the Eligibility and
enrollment chapter.
If you drop coverage and reenroll
If you drop coverage and reenroll within 30 days, you will
automatically be reenrolled for the same coverage you had
prior to dropping coverage (or the most similar coverage
offered under the Plan).
If you drop coverage and reenroll after 30 days, you will be
considered newly eligible and may enroll for coverage under
the time periods and conditions described in the Eligibility
and enrollment chapter.
IF A DEPENDENT IS DROPPED FROM
COVERAGE AND REENROLLED
If your dependent child is dropped from coverage and then
determined to be eligible for coverage within 30 days, the
dependent will automatically be reenrolled in the same
coverage you elect for yourself.
If your dependent regains eligibility and is reenrolled after
30 days, they will be treated as a newly eligible dependent.
The associate may enroll them for coverage under the
time periods and conditions described in the Eligibility and
enrollment chapter.
Company-paid
life insurance
Company‑paid life insurance
Naming a beneficiary
When your company‑paid life insurance coverage begins
Early payout due to terminal illness
Filing a claim
When benefits are not paid
When coverage ends
EstateGuidance®
Continuing your company‑paid life insurance after you leave Walmart
If you leave the company and are rehired
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This information is intended to be a summary of your benefits and may not include all policy provisions. If
there is a discrepancy between this document and the policy issued by Prudential regarding the calculation
of benefits and limitations under the policy, the terms of the policy will govern. You may obtain a copy of
this policy by contacting the Plan.
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Company-paid life insurance
Life insurance is automatically provided by Walmart at no cost to you. So you can rest easy
knowing your loved ones will have financial help if the unthinkable happens.
RESOURCES
Find What You Need
Online
Other Resources
Change your beneficiary designation
Go to One.Walmart.com
• Get more coverage details
• Request an accelerated benefit
• Get details about continuing
your insurance
File a claim
Beneficiary changes cannot be made
over the phone
Call Prudential at 877-740-2116
Call Prudential at 877-740-2116
What you need to know about company-paid life insurance
• If you are a full‑time hourly or management associate, Walmart provides you with life insurance coverage at no cost to
you (for details about eligible job classifications, see the Enrollment and effective dates by job classification charts in
the Eligibility and enrollment chapter). No enrollment is necessary, and Proof of Good Health is not required.
• Your coverage amount is equal to your annualized rate of pay, including overtime and bonuses, during the one‑year
period prior to your death, rounded to the nearest $1,000, to a maximum of $50,000.
• An early payout due to terminal illness is available.
• Coverage is provided through The Prudential Insurance Company of America (Prudential).
• This policy is term life insurance. It has no cash value.
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Company-paid life insurance
If you are a full‑time hourly or management associate,
Walmart provides you with life insurance coverage at no
cost to you (for details about eligible job classifications, see
the Enrollment and eligibility dates by job classification
charts in the Eligibility and enrollment chapter). No
enrollment is necessary.
Your company‑paid coverage amount is equal to your
annualized rate of pay, including overtime and bonuses,
during the one‑year period prior to your death, rounded to
the nearest $1,000, to a maximum of $50,000.
CHANGING YOUR BENEFICIARY
You can change your beneficiary(ies) at any time on
One.Walmart.com. Any change in beneficiary must be
completed and submitted to Walmart before your death and
can be submitted only by you, the covered associate.
IF YOU DO NOT NAME A BENEFICIARY
If no beneficiary is named or there is no surviving
beneficiary at the time of your death, payment will be made
to surviving family members in the following order:
1. Spouse or partner of the deceased; if not surviving, then
Naming a beneficiary
To ensure your company‑paid life insurance benefit is paid
according to your wishes, you must name a beneficiary(ies).
You may do this by going to One.Walmart.com. Note that
only beneficiary designations made online are accepted.
You can name anyone you wish. If the beneficiary(ies) you
list with Walmart differs from the beneficiary(ies) named in
your will, the list that Walmart has prevails. If you have not
designated a beneficiary(ies) under the company‑paid life
insurance benefit, payment will be made to your surviving
family members as described under If you do not name a
beneficiary later in this chapter.
The following information is needed for each beneficiary:
• Name
• Current address and phone number
• Relationship to you
• Social Security number
• Date of birth, and
• The percentage you wish to designate per beneficiary,
up to 100%.
If two or more beneficiaries are designated and their
shares are not specified, they will share the insurance
benefit equally. If a named beneficiary dies before you, that
beneficiary’s interest will end, and will be shared equally
by any remaining beneficiaries unless your beneficiary
form states otherwise. If you and a beneficiary die in the
same event and it cannot be determined who died first, the
beneficiary will be treated as having died before you.
You can name a minor as a beneficiary; however, Prudential
may not be legally permitted to pay the minor until the minor
reaches legal age. You may want to consult an attorney or an
estate planner before naming a minor as a beneficiary. If you
name a minor as a beneficiary, funeral expenses cannot be
paid from the minor’s beneficiary proceeds.
2. Children in equal shares; if not surviving, then
3. Parents in equal shares; if not surviving, then
4. Siblings in equal shares; if not surviving, then
5. Your estate.
Be sure to keep your beneficiary information
up to date. Proceeds go to whoever is listed
on your beneficiary form with Walmart,
regardless of your current relationship with
that person, unless state law says otherwise.
You can change your beneficiary(ies) at any
time on One.Walmart.com.
When your company-paid life
insurance coverage begins
Company‑paid life insurance coverage begins on the
date specified in the Enrollment and effective dates by
job classification charts in the Eligibility and enrollment
chapter. You must be actively at work for your coverage to
become effective. You are considered actively at work if
you are on active status and not on a leave of absence. See
the Eligibility and enrollment chapter for details.
Early payout due to terminal illness
If you are terminally ill, you may elect to receive an
“accelerated benefit” while you are still living of up to 50%
of the amount your beneficiary(ies) would have received
upon your death (measured on the date you provide proof
of your terminal illness). Payment is made in a lump sum.
Upon your death, your beneficiary(ies) receives the greater
of (a) 100% of your annual earnings, based on the most
recent average salary for the last 26 pay‑periods, reduced
by the amount of any terminal illness proceeds paid under
the option to accelerate payment of death benefits, or
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(b) the amount of insurance in effect prior to payment
of any terminal illness proceeds, reduced by the amount
of any terminal illness proceeds paid under the option to
accelerate payment of death benefits.
If you terminate from the company after you have received
(or begun to receive) the accelerated benefit, you will need
to convert the policy for your beneficiary(ies) to receive the
remaining balance upon your death. If you do not convert
the policy upon termination of your employment, no benefit
will be payable to your beneficiary(ies). See the Continuing
your company-paid life insurance after you leave Walmart
section in this chapter for details on conversion.
Under the policy, you are considered terminally ill if death
is expected within 12 months and a doctor can certify the
illness or injury as terminal.
There may be circumstances in which the accelerated
benefit is not paid. Contact Prudential at 877-740-2116
for details.
Please consult with a tax professional to assess the impact
of this benefit.
Filing a claim
The following information must be provided to Prudential
regarding the deceased associate:
• Name
• Social Security number
• Date of death, and
• Cause of death (if known).
An original or certified copy of the death certificate is
required as proof of death. The death certificate should be
mailed to:
The Prudential Insurance Company of America
Group Life Claim Division
P.O. Box 8517
Philadelphia, Pennsylvania 19176
The claim will not be finalized until Prudential receives the
death certificate. Acceptance of the death certificate is not
a guarantee of payment.
Claims are determined under the time frames and
requirements set out in the Claims and appeals chapter.
Your beneficiary(ies) has the right to appeal a claim denial.
Benefits are paid according to the terms of the insurance
policy. For details, contact Prudential at 877-740-2116.
If your death occurs outside a 100‑mile radius of your home,
there is a benefit for expenses incurred to return your body
to either a preferred location within the United States,
or to your residence at the time of death. The benefit
includes expenses for embalming, cremation, a coffin, and
transportation of your remains. The benefit is the lesser of
the cost to return your remains or $10,000.
When benefits are not paid
Benefits are not paid to any beneficiary(ies) who engaged
in an illegal act that resulted in the associate’s death.
The benefit in this circumstance would go to another
eligible designated beneficiary or, if there is no other
surviving beneficiary, to a beneficiary in the default list,
as specified under If you do not name a beneficiary earlier
in this chapter.
When coverage ends
Your company‑paid life insurance coverage ends:
• At termination of your employment
• On the last day of the pay period when your job status
changes to part‑time
• On the date of your death
• On the date that you lose eligibility
• On the last day of an approved leave of absence (unless
you return to work), or
• When the benefit is no longer offered by the company.
This policy is term life insurance. It has no cash value.
EstateGuidance®
EstateGuidance offers you the convenience of online
will preparation from your personal computer at no cost
to you. Wills ensure that your assets will be distributed
in accordance with your wishes and allow you to name
a guardian of your minor children. To complete the
online will questionnaire, log on to willguidance.com,
password: Walmart.
NOTE: Your will does not override the beneficiary
designation on a life insurance policy or retirement account
(such as a 401(k) plan). For this reason, be sure to review
your beneficiary designations, particularly after you have
created a will, to make sure your designations are consistent
and fully in line with your wishes. If the beneficiary(ies) you
have listed with Walmart differs from the beneficiary(ies)
named in your will, the list that Walmart has prevails.
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Continuing your company-paid life
insurance after you leave Walmart
In most circumstances, you have two options to continue
your company‑paid life insurance if your group life coverage
ends. The first option, called portability, allows you to
continue all or a portion of your coverage through a group
term policy with Prudential. The second option, called
conversion, allows you to convert all or a portion of your
coverage to a Prudential individual policy.
Conversion is a required Plan provision that allows you
to convert your life insurance coverage to an individual
policy if coverage would end due to your termination
of employment or transfer from an eligible class. Proof
of Good Health is not required. Rates are based on your
age and amount converted. You have 31 days from the
termination date of coverage to request to convert your
coverage to an individual policy. If your death occurs during
the 31‑day conversion period, the death benefit will be
payable up to the amount that could have been converted.
If you are a resident of Minnesota, you have a continuation
right instead of a conversion right when you lose coverage
due to a reduction in your hours or termination of
employment (other than for gross misconduct). You may
elect to continue coverage at your expense until you obtain
coverage under another group life insurance policy; however,
the maximum period that coverage may be continued is
18 months. If you continue coverage, at the expiration of
the continuation period you may convert your life insurance
coverage to an individual policy, as described above.
To request information on portability or conversion, call
Prudential at 877-740-2116.
If you leave the company and
are rehired
If you return to work for the company as a full‑time
hourly or management associate within 13 weeks, you will
automatically be reenrolled for coverage.
If you return to work after 13 weeks, you will be considered
newly eligible and will be required to complete the
applicable eligibility waiting period. See the Eligibility and
enrollment chapter for details.
You must apply for portability or conversion within 31 days
of the date your company‑paid coverage ends. If you die
within 31 days of a qualifying loss of coverage and before
electing portability or conversion of your life insurance
coverage, Prudential will pay a death benefit to your
beneficiary. The benefit will be paid based on the amount of
coverage in effect prior to the qualifying loss of coverage,
even if you did not apply for portability or conversion of
your coverage.
Portability enables you to maintain similar term life
insurance with Prudential after your employment ends,
if certain conditions are met. Proof of Good Health is
required to “port” your coverage. If you do not pass or do
not submit Proof of Good Health, you will be eligible to
convert your company‑paid life insurance to an individual
policy, as described in the next column.
You can apply for term life coverage under the portability
feature if you meet all of these conditions:
• Your company‑paid life coverage ends for any reason
other than:
– you leave the company due to a disability, or
– Walmart changes group life insurance carriers and you
are, or become, eligible within the next 31 days.
• You are actively at work on the day your company‑paid
insurance ends.
• You are less than age 80.
• Your amount of insurance is at least $20,000 on the day
your company‑paid insurance ends.
If you meet these conditions, you will have 31 days from
your termination date to contact Prudential and enroll.
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Optional associate
life insurance
Optional associate life insurance
Naming a beneficiary
When your optional associate life insurance coverage begins
Early payout due to terminal illness
Filing a claim
When benefits are not paid
Break in coverage
When coverage ends
Continuing your optional associate life insurance after you leave Walmart
If you leave the company and are rehired
If you drop or decrease your coverage and reenroll
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This information is intended to be a summary of your benefits and may not include all policy provisions. If
there is a discrepancy between this document and the policy issued by Prudential regarding the calculation
of benefits and limitations under the policy, the terms of the policy will govern. You may obtain a copy of
this policy by contacting the Plan.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Optional associate life insurance
Optional associate life insurance takes care of your family by giving them extra financial
protection during a difficult time.
RESOURCES
Find What You Need
Online
Other Resources
Change your beneficiary designation
Go to One.Walmart.com
• Get more details
• Request an accelerated benefit
• Get details about continuing your
insurance
File a claim
Beneficiary changes cannot be made
over the phone
Call Prudential at 877-740-2116
Call Prudential at 877-740-2116
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What you need to know about optional associate life insurance
• If you are an hourly or management associate, you can enroll in optional associate life insurance when you are
eligible, as described in the Eligibility and enrollment chapter.
• Depending on the amount of coverage you choose and when you enroll, you may be required to provide Proof of
Good Health.
• You can enroll in, change, or drop optional associate life insurance at any time, but if you enroll at any time other
than your initial enrollment period, you will have to provide Proof of Good Health.
• An early payout due to terminal illness is available.
• Coverage is provided through The Prudential Insurance Company of America (Prudential).
• This policy is term life insurance. It has no cash value.
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Optional associate life insurance
Optional associate life insurance protects your family if you
die while coverage is in effect. If you become terminally ill, a
benefit may be payable to you while you are still living.
If you are an hourly or management associate you can enroll
in optional associate life insurance when you are eligible, as
described in the Eligibility and enrollment chapter.
Your coverage choices for optional associate life insurance
depend on your job classification, as reflected in the
company’s payroll system. The coverage amounts you can
choose are shown in the chart below.
HOURLY ASSOCIATES AND
PART‑TIME TRUCK DRIVERS
MANAGEMENT
ASSOCIATES
$25,000
$50,000
$100,000
$25,000
$200,000
$150,000
$50,000
$300,000
$75,000
$200,000
$75,000
$500,000
$100,000
$750,000
$150,000
$1,000,000
For details about eligible job classifications, see the Enrollment
and eligibility dates by job classification section in the
Eligibility and enrollment chapter
If you die, your beneficiary(ies) may receive a lump sum
payment for the coverage amount you select.
The cost of optional associate life insurance is based on the
coverage amount you select, your age, and whether you
are eligible for tobacco‑free rates. Premiums from optional
associate life coverage do not subsidize coverage under
company‑paid life insurance.
If you are an hourly associate, part‑time truck driver, or
management associate, you can enroll in optional associate
life insurance at any time once you are eligible. Proof of
Good Health may be required when you enroll, depending
on the coverage amount you choose and when you enroll.
You can change or drop coverage at any time. However, you
will be required to provide Proof of Good Health if you want
to increase your coverage or reenroll for any amount of
coverage after dropping coverage.
See the Company-paid life insurance chapter
for information about other life insurance
coverage available to full‑time hourly and
management associates.
PROOF OF GOOD HEALTH
Proof of Good Health is required for optional associate life
insurance if:
• The coverage amount selected is above $25,000 during
your initial enrollment period
• You enroll after your initial enrollment period for any
amount, or
• You increase your coverage after your initial
enrollment period.
Proof of Good Health includes completing a questionnaire
regarding your medical history and possibly having a
medical exam. The Proof of Good Health questionnaire
is made available when you enroll.
Naming a beneficiary
To ensure that your life insurance benefit is paid according
to your wishes, you must name a beneficiary(ies) to receive
your optional associate life insurance benefit if you die. You
may do this by going to One.Walmart.com. Any change in
beneficiary must be completed and submitted to Walmart
before your death and can be submitted only by you, the
covered associate. Note that only beneficiary designations
made online are accepted.
You can name anyone you wish. If the beneficiary(ies)
you list with Walmart differs from the beneficiary(ies)
named in your will, the list that Walmart has prevails. If you
have not designated a beneficiary(ies) under the optional
associate life insurance benefit, payment will be made to
your surviving family members as described under If you do
not name a beneficiary later in this chapter.
The following information is needed for each beneficiary:
• Name
• Current address and phone number
• Relationship to you
• Social Security number
• Date of birth, and
• The percentage you wish to designate per beneficiary,
up to 100%.
If two or more beneficiaries are designated and their
shares are not specified, they will share the insurance
benefit equally. If a named beneficiary dies before you,
that beneficiary’s interest will end and will be shared equally
by any remaining beneficiary(ies), unless your beneficiary
form states otherwise. If you and a beneficiary die in the
same event and it cannot be determined who died first,
the beneficiary will be treated as having died before you.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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You can name a minor as a beneficiary; however, Prudential
may not be legally permitted to pay the minor until the minor
reaches legal age. You may want to consult an attorney or an
estate planner before naming a minor as a beneficiary. If you
name a minor as a beneficiary, funeral expenses cannot be
paid from the minor’s beneficiary proceeds.
CHANGING YOUR BENEFICIARY
You can change your beneficiary(ies) at any time on
One.Walmart.com. Any change in beneficiary must be
completed and submitted to Walmart before your death and
can be submitted only by you, the covered associate.
Be sure to keep your beneficiary information
up to date. Proceeds will go to whoever is
listed on your beneficiary form with Walmart,
regardless of your current relationship with
that person, unless state law says otherwise.
You can change your beneficiary(ies) at any
time on One.Walmart.com.
IF YOU DO NOT NAME A BENEFICIARY
If no beneficiary is named or there is no surviving
beneficiary at the time of your death, payment will be made
to surviving family members in the following order:
1. Spouse or partner of the deceased; if not surviving, then
2. Children in equal shares; if not surviving, then
3. Parents in equal shares; if not surviving, then
4. Siblings in equal shares; if not surviving, then
5. Your estate.
When your optional associate life
insurance coverage begins
When Proof of Good Health is required (as described on the
previous page), your coverage becomes effective the day
the company receives approval from Prudential or at the
end of your eligibility waiting period, whichever is later.
If you should die before Prudential approves coverage, no
optional associate life insurance benefit will be paid to your
beneficiary(ies).
Early payout due to terminal illness
If you are terminally ill, you may elect to receive an
“accelerated benefit” while you are still living of up to 50%
of the coverage amount your beneficiary(ies) would have
received upon your death, up to a $250,000 maximum.
Payment is made in a lump sum. Upon your death, your
beneficiary(ies) receives the total amount of coverage
in effect at your death minus the amount of early payouts
you received before your death).
If you terminate from the company after you have
received (or begun to receive) the accelerated
benefit, you will need to convert the policy for your
beneficiary(ies) to receive the remaining balance upon
your death. If you do not convert the policy upon
termination of your employment, no benefit will be
payable to your beneficiary(ies). See the Continuing your
optional associate life insurance after you leave Walmart
section later in this chapter for details on conversion.
Under the policy, you are considered terminally ill if death
is expected within 12 months and a doctor can certify the
illness or injury as terminal.
There may be circumstances in which the accelerated
benefit is not paid. Contact Prudential at 877-740-2116
for details.
Please consult a tax professional to assess the impact of
this benefit.
Filing a claim
The following information must be provided to Prudential
regarding the deceased associate:
• Name
• Social Security number
• Date of death, and
• Cause of death (if known).
An original or certified copy of the death certificate is
required as proof of death. The death certificate should be
mailed to:
The Prudential Insurance Company of America
Group Life Claim Division
P.O. Box 8517
Philadelphia, Pennsylvania 19176
When Proof of Good Health is not required, your coverage
becomes effective on the date you enroll or at the end of
your eligibility waiting period, whichever is later.
The claim will not be finalized until Prudential receives the
death certificate. Acceptance of the death certificate is not
a guarantee of payment.
In either case, you must be actively at work for your coverage
to become effective. You are considered actively at work
if you are on active status and not on a leave of absence.
See the Eligibility and enrollment chapter for details.
Claims are determined under the time frames and
requirements set out in the Claims and appeals chapter.
Your beneficiary has the right to appeal a claim denial.
Benefits are paid according to the terms of the insurance
policy. For more details, contact Prudential at 877-740-2116.
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When benefits are not paid
No benefits are paid to your beneficiary(ies) if you die as
a result of suicide while sane or insane during the first two
years of coverage. If you increase your coverage and you
die as a result of suicide within two years of the date you
increase your coverage, your beneficiary(ies) will receive
the prior coverage amount.
If your beneficiary(ies) files a claim within the first two
years of your approval date, Prudential has the right to
re‑examine your Proof of Good Health questionnaire.
If material facts about you are found to have been stated
inaccurately, the true circumstances will be used to
determine what amount of coverage should have been in
effect, if any, and:
• The claim may be denied, and
• Premiums paid may be refunded.
Break in coverage
There may be occasions in which you must make special
arrangements to pay your optional associate life insurance
premiums to avoid a break in coverage. These situations
occur most commonly if you are on a leave of absence or
if your Walmart paycheck is not sufficient to pay your full
share of the cost of coverage (such as after a reduction in
hours). Failure to make your premium payments by the due
date may result in an interruption in the payment of any
benefit claims and/or a break in coverage.
For details on the impact a break in coverage may have,
and on how to make personal payments to continue your
coverage, see When special arrangements are necessary to
maintain coverage in the Eligibility and enrollment chapter.
IF YOU GO ON A LEAVE OF ABSENCE
You may continue your coverage up to the last day of an
approved leave of absence, provided that you pay your
premiums before or during the leave. For information about
making payments while on a leave of absence, see When
special arrangements are necessary to maintain coverage in
the Eligibility and enrollment chapter.
When coverage ends
Your optional associate life insurance coverage ends:
• At termination of your employment
• On the last day of coverage for which premiums were paid,
if you fail to pay your premiums within 30 days of the date
your premium is due
• On the date of your death
• On the last day of an approved leave of absence (unless
you return to work)
• When the benefit is no longer offered by the company, or
• On the day after you drop coverage.
This policy is term life insurance. It has no cash value.
Continuing your optional
associate life insurance after
you leave Walmart
In most circumstances, you have two options to continue
your optional associate life insurance if your group life
coverage ends. The first option, called portability, allows
you to continue all or a portion of your current coverage
through a group term policy with Prudential. The second
option, called conversion, allows you to convert all or a
portion of your coverage to a Prudential individual policy.
You must apply for portability or conversion within 31 days
of the date your coverage ends. If you die within 31 days of
a qualifying loss of coverage and before electing portability
or conversion of your life insurance coverage, Prudential
will pay a death benefit to your beneficiary. The benefit will
be paid based on the amount of coverage in effect prior to
the qualifying loss of coverage, even if you did not apply for
portability or conversion of your coverage.
Portability enables you to maintain similar term life
insurance with Prudential after your employment ends if
certain conditions are met. Proof of Good Health is not
required to “port” your coverage. You can, however, receive
preferred rates similar to the rates you paid while an active
associate if you submit and pass Proof of Good Health. If
you do not pass or do not submit Proof of Good Health, your
rates will be based on Prudential’s standard portability rates.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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If you leave the company and
are rehired
If you return to work for the company within 13 weeks,
you will automatically be reenrolled for the same coverage
in effect prior to leaving the company (or the most
similar coverage offered under the Plan). You can drop or
otherwise change your coverage at any time.
If you return to work after 13 weeks, you will be considered
newly eligible and will be required to complete the
applicable eligibility waiting period. Proof of Good Health
is required for coverage plans above $25,000 (or for any
amount if you enroll after your initial enrollment period).
See the Eligibility and enrollment chapter for details.
If you drop or decrease your
coverage and reenroll
If you drop or decrease your coverage and reenroll within
30 days, you may reenroll for the same coverage in effect
prior to dropping or decreasing coverage.
If you reenroll more than 30 days after dropping or
decreasing your coverage, Proof of Good Health will
be required.
You can apply for term life coverage under the portability
feature if you meet all of these conditions:
• Your optional associate life coverage ends for any reason
other than:
– your failure to pay premiums while an active associate
– you leave the company due to a disability, or
– Walmart changes group life insurance carriers and you
are, or become, eligible within the next 31 days.
• You meet the active work requirement on the day your
insurance ends.
• You are less than age 80.
• Your amount of insurance is at least $20,000 on the day
your insurance ends.
If you meet these conditions, you will have 31 days from
your termination date to contact Prudential and enroll.
Prudential will notify you of the amount of portability
coverage offered. The amount of insurance coverage
offered will not be more than the amount of coverage you
elected under the plan (and not more than five times your
annual earnings), and will not be less than $20,000.
Conversion is a required Plan provision that allows you
to convert your life insurance coverage to an individual
policy if coverage would end due to your termination
of employment or transfer from an eligible class. Proof
of Good Health is not required. Rates are based on your
age and amount converted. You have 31 days from the
termination date of coverage to request to convert your
coverage to an individual policy. If your death occurs during
the 31‑day conversion period, the death benefit will be
payable up to the amount that could have been converted.
If you are a resident of Minnesota, you have a continuation
right instead of a conversion right when you lose coverage
due to a reduction in your hours or termination of
employment (other than for gross misconduct). You may
elect to continue coverage at your expense until you
obtain coverage under another group life plan; however,
the maximum period that coverage may be continued is 18
months. If you continue coverage, at the expiration of the
continuation period you may convert your life insurance
coverage to an individual policy, up to the amount of
coverage in effect at that time. You have 31 days from the
date continuation coverage would end to request to convert
your coverage to an individual policy.
To request information on portability or conversion, call
Prudential at 877-740-2116.
Optional dependent
life insurance
Optional dependent life insurance
When your optional dependent life insurance coverage begins
Additional benefits
Filing a claim
When benefits are not paid
Break in coverage
When coverage ends
Continuing spouse/partner coverage after you leave Walmart
If you leave the company and are rehired
If you drop or decrease your coverage and reenroll
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This information is intended to be a summary of your benefits and may not include all policy provisions. If
there is a discrepancy between this document and the policy issued by Prudential regarding the calculation
of benefits and limitations under the policy, the terms of the policy will govern. You may obtain a copy of
this policy by contacting the Plan.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Optional dependent life insurance
Optional dependent life insurance can help ease your financial situation if you lose someone close
to you, like a spouse, partner, or child.
RESOURCES
Find What You Need
Online
Other Resources
Get more details
File a claim
Go to One.Walmart.com
Call Prudential at 877-740-2116
Call Prudential at 877-740-2116
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What you need to know about optional dependent life insurance
• If you are an hourly or management associate, you can enroll your eligible dependents in optional dependent life
insurance when you are eligible, as described in the Eligibility and enrollment chapter. Full‑time hourly and management
associates can enroll their spouse/partners and/or their children; part‑time hourly associates and part‑time truck drivers
can enroll their children but not their spouse/partners.
• Proof of Good Health for your spouse/partner is required if you enroll for a coverage amount above $5,000 during
your initial enrollment period, or for any coverage amount if you enroll at any other time. Proof of Good Health is not
required for your children.
• Coverage is provided through the Prudential Insurance Company of America (Prudential).
• This policy is term life insurance. It has no cash value.
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Optional dependent life insurance
Optional dependent life insurance pays you a financial
benefit if you are an enrolled associate and your dependent
dies while coverage is in effect. If you are an hourly
or management associate, you can enroll in optional
dependent life insurance when you are eligible, as described
in the Eligibility and enrollment chapter.
All full‑time hourly and management associates can enroll
their spouses/partners and/or children. All part‑time
hourly associates, part‑time truck drivers, and temporary
associates can enroll their children but cannot enroll their
spouses/partners.
For details about eligible job classifications, see the
Enrollment and eligibility dates by job classification charts
in that chapter.
When you enroll in optional dependent life insurance, if your
covered spouse/partner and/or legal dependent dies, you
may receive a lump sum payment for the coverage amount
you select. The coverage choices for optional dependent
life insurance are as follows:
SPOUSE/PARTNER COVERAGE*
CHILD COVERAGE
$5,000
$15,000
$25,000
$50,000
$75,000
$100,000
$150,000
$200,000
$5,000
$10,000
$20,000
* Not available for part‑time hourly associates, temporary
associates, or part‑time truck drivers
Depending on the coverage amount you choose and when
you enroll, your spouse/partner may be required to provide
Proof of Good Health.
You (the associate) are automatically assigned as the
primary beneficiary of your dependent’s life insurance
coverage. If you and your covered dependent or
dependents die at the same time, benefits are paid to your
dependent’s estate or, at Prudential’s option, to a surviving
relative of the dependent.
The cost of optional dependent life insurance for your
spouse/partner is based on the coverage amount you select,
your (the associate’s) age, and whether your spouse/partner
is eligible for the tobacco‑free rates. The cost of coverage
for your children is based on the coverage amount you
select. Premiums from optional dependent life coverage do
not subsidize coverage under company‑paid life insurance.
You can enroll in optional dependent life insurance at any time.
Proof of Good Health is required for your spouse/partner if
you enroll after your initial enrollment period. Also, you can
change or drop coverage at any time. However, if you want
to increase your spouse/partner’s coverage or reenroll after
dropping coverage, you will be required to provide Proof of
Good Health for your spouse/partner.
PROOF OF GOOD HEALTH
Proof of Good Health is required for your spouse/partner’s
optional dependent life insurance coverage if:
• The coverage amount selected is above $5,000
during your initial enrollment period
• You enroll after your initial enrollment period for
any amount, or
• You increase your coverage after your initial
enrollment period.
However, within 60 days of marriage/partnership, you may
elect to cover your spouse/partner or change the amount
of insurance for your spouse/partner. In this instance,
even though you are outside your initial enrollment
period, your spouse/partner is not required to provide
Proof of Good Health unless you select a coverage
amount greater than $5,000.
Proof of Good Health includes completing a questionnaire
regarding your spouse/partner’s medical history and
possibly requiring your spouse/partner to have a medical
exam. The Proof of Good Health questionnaire is made
available when you enroll your spouse/partner. Proof of
Good Health is not required for children.
When your optional dependent life
insurance coverage begins
When Proof of Good Health is required (as described above),
coverage for your spouse/partner becomes effective the
day the company receives approval from Prudential or at
the end of your eligibility waiting period, whichever is later.
Proof of Good Health is not required for children.
If your spouse/partner should die before Prudential
approves coverage, no optional dependent life insurance
will be paid to you.
When Proof of Good Health is not required, coverage for
your spouse/partner or child becomes effective on the date
you enroll or at the end of your eligibility waiting period,
whichever is later.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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If your spouse/partner or dependent child is confined
for medical treatment (at home or elsewhere), coverage
is delayed until the spouse/partner or child has a medical
release (does not apply to a newborn child).
You must be actively at work for your dependent coverage
to become effective. You are considered actively at work if
you are on active status and not on a leave of absence. See
the Eligibility and enrollment chapter for details.
The claim will not be finalized until Prudential receives the
death certificate. Acceptance of the death certificate is not
a guarantee of payment.
Claims are determined under the time frames and
requirements set out in the Claims and appeals chapter.
You have the right to appeal a claim denial.
Benefits are paid according to the terms of the insurance
policy. For more details, contact Prudential at 877-740-2116.
Additional benefits
Benefits also are payable under the following
circumstances:
• If a dependent child is born alive and dies within 60 days
of birth and was eligible but not enrolled in optional
dependent life insurance prior to the loss—with a live birth
certificate and a death certificate—Prudential will pay a
$5,000 benefit only.
• If a dependent child is stillborn, Prudential will pay a
$5,000 benefit to associates who have met the eligibility
waiting period for dependent life insurance. See the
Eligibility and enrollment chapter for details. A stillborn
child is defined as an eligible associate’s natural‑born
child whose death occurs before expulsion, extraction,
or delivery and whose fetal weight is 350 grams or more;
or, if fetal weight is unknown, whose duration in utero
was 20 or more complete weeks of gestation. If both the
mother and father of the stillborn child work at Walmart,
each associate is eligible to submit a claim for this benefit
separately, for a total of $10,000.
Filing a claim
The following information must be provided to Prudential
regarding the deceased dependent:
• Name
• Social Security number
• Date of death, and
• Cause of death (if known).
An original or certified copy of the death certificate is
required as proof of death. Mail the death certificate to:
The Prudential Insurance Company of America
Group Life Claim Division
P.O. Box 8517
Philadelphia, Pennsylvania 19176
When benefits are not paid
No benefits are paid to you if your spouse/partner dies as
a result of suicide while sane or insane during the first two
years of coverage. If you increase your spouse/partner’s
coverage and your spouse/partner dies as a result of suicide
within two years of the increase in coverage, you will receive
the prior coverage amount.
If you file a claim for your spouse/partner within the first
two years of your approval date, Prudential has the right to
re‑examine your spouse/partner’s Proof of Good Health
questionnaire. If material facts about your spouse/partner
are found to have been stated inaccurately, the true
circumstances will be used to determine what amount of
coverage should have been in effect, if any, and:
• The claim may be denied, and
• Premiums paid may be refunded.
Break in coverage
There may be occasions in which you must make special
arrangements to pay your optional dependent life insurance
premiums to avoid a break in coverage. These situations
occur most commonly if you are on a leave of absence or
if your Walmart paycheck is not sufficient to pay your full
share of the cost of coverage (such as after a reduction in
hours). Failure to make your premium payments by the due
date may result in an interruption in the payment of any
benefit claims and/or a break in coverage.
For details on the impact a break in coverage may have,
and on how to make personal payments to continue your
coverage, see When special arrangements are necessary to
maintain coverage in the Eligibility and enrollment chapter.
IF YOU GO ON A LEAVE OF ABSENCE
You may continue your coverage up to the last day of an
approved leave of absence, provided that you pay your
premiums before or during the leave. For information about
making payments while on a leave of absence, see When
special arrangements are necessary to maintain coverage in
the Eligibility and enrollment chapter.
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When coverage ends
Your optional dependent life insurance coverage ends:
• At termination of your employment
• On the last day of coverage for which premiums were paid,
if you fail to pay your premiums within 30 days of the date
your premium is due
• On the date of your death
• On the date that you or a dependent spouse/partner
or child loses eligibility (see the Eligibility and
enrollment chapter)
• On the last day of an approved leave of absence (unless
you return to work)
Proof of Good Health is not required to “port” your
spouse/partner coverage. You can, however, receive
preferred rates for spouse/partner coverage similar
to the rates you paid while an active associate if your
spouse/partner submits and passes Proof of Good Health.
If you do not pass or submit Proof of Good Health for your
spouse/partner, your rates will be based on Prudential’s
standard portability rates.
You can apply for term life coverage under the portability
feature if you meet all of these conditions:
• The optional dependent life coverage ends because your
optional associate life coverage ends for any reason
other than:
• When the benefit is no longer offered by the company, or
– your failure to pay premiums while an active associate
• The day after you drop your coverage.
– the end of your employment on account of your
In addition, if you have optional dependent life coverage for
your spouse/partner and your job status changes to part‑time
hourly associate, temporary associate, or part‑time truck
driver, your coverage for your spouse/partner will end on the
last day of the pay period when your job status changes.
This policy is term life insurance. It has no cash value.
Continuing spouse/partner coverage
after you leave Walmart
If you are a full‑time or management associate and
carry optional dependent life insurance for your spouse
or partner, you have two options to continue your
spouse/partner coverage after your group life coverage
ends. The first option, called portability, allows you and
your spouse or partner to continue all or a portion of
your current coverage through a group term policy with
Prudential. The second option, called conversion, allows
you to convert all or a portion of your spouse/partner
coverage to a Prudential individual policy. These options
are not available to part‑time hourly associates, temporary
associates, or part‑time truck drivers.
You must apply for portability or conversion within 31 days of
the date your spouse/partner coverage ends. If your spouse
or partner dies within 31 days of a qualifying loss of coverage
and before electing portability or conversion of the life
insurance coverage, Prudential will pay a death benefit.
The benefit will be the amount of coverage your spouse or
partner could have converted, even if your dependent did
not apply for portability or conversion of coverage.
Portability enables you to maintain similar term life
insurance for your spouse or partner with Prudential after
your associate coverage ends or your spouse or partner
loses eligibility due to divorce or separation, if certain
conditions are met.
retirement due to disability, or
– the end of the optional associate life coverage for all
associates when such coverage is replaced by group life
insurance from any carrier for which you are or become
eligible within the next 31 days.
• You apply and become covered for term life coverage
under the portability plan.
• With respect to a dependent spouse or partner, that
person is less than age 80.
• The dependent is covered for optional dependent
life coverage on the day your optional associate life
coverage ends.
• The dependent is not confined for medical care or
treatment, at home or elsewhere, on the day your optional
associate life coverage ends.
Your spouse or partner may also apply for term life
coverage under the portability feature if they meet all of
these conditions:
• Your spouse or partner’s coverage ends due to divorce or
termination of partnership.
• Your spouse or partner is less than age 80.
• Your spouse or partner is not confined for medical care or
treatment, at home or elsewhere, on the day your optional
dependent life coverage ends.
If you meet these conditions, you will have 31 days
from your termination date to contact Prudential
and enroll. Prudential will notify you of the amount of
portability coverage offered. The amount of insurance
coverage offered will not be more than the amount of
spouse/partner coverage you elected under the plan.
However, if your spouse or partner provides Proof of
Good Health, and Prudential accepts such proof, you may
increase the amount of your spouse or partner’s coverage
by $20,000 (or, if less, by your annual earnings amount).
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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If you drop or decrease your
coverage and reenroll
If you drop or decrease your coverage and reenroll within
30 days, you may reenroll for the same coverage in effect
you had prior to dropping or decreasing coverage.
If you reenroll more than 30 days after dropping or
decreasing coverage, Proof of Good Health will be required
for spouse/partner coverage plans.
IF A DEPENDENT IS DROPPED FROM
COVERAGE AND REENROLLED
If your dependent child is dropped from coverage and then
determined to be eligible for coverage within 30 days, the
dependent will automatically be reenrolled in the same
coverage you elect for yourself.
If your dependent regains eligibility and is reenrolled after
30 days, they will be treated as a newly eligible dependent.
The associate may enroll them for coverage under the
time periods and conditions described in the Eligibility and
enrollment chapter.
Conversion is a required Plan provision that allows you to
convert your life insurance coverage to an individual policy
if coverage would end for any reason other than failure
to pay premiums or the end of dependent coverage for
all associates. Proof of Good Health is not required. Rates
are based on your dependent’s age and amount converted.
You have 31 days from the termination date of coverage to
request to convert your coverage to an individual policy. If
your dependent’s death occurs during the 31‑day conversion
period, the death benefit will be payable up to the amount
that could have been converted.
If you are a resident of Minnesota, you have a continuation
right instead of a conversion right when you lose coverage
due to a reduction in your hours or termination of
employment (other than for gross misconduct). You may
elect to continue coverage at your expense until you
obtain coverage under another group life insurance policy;
however, the maximum period that coverage may be
continued is 18 months. If you continue coverage, at the
expiration of the continuation period, you may convert your
life insurance coverage to an individual policy, up to the
amount of coverage in effect at that time. You have 31 days
from the date continuation coverage would end to request
to convert your coverage to an individual policy. In addition,
if you lose coverage for any reason other than a reduction
in your hours or termination of employment (other than for
gross misconduct), you may convert up to the amount of
coverage that was in force under the plan.
To request information on portability or conversion, call
Prudential at 877-740-2116.
If you leave the company and
are rehired
If you return to work for the company within 13 weeks,
you will automatically be reenrolled for the same coverage
you had prior to leaving the company (or the most
similar coverage offered under the Plan). You can drop or
otherwise change this coverage at any time.
If you return to work after 13 weeks, you will be considered
newly eligible and will be required to complete the applicable
eligibility waiting period. Proof of Good Health is required
for spouse/partner coverage plans above $5,000 (or for any
amount if you enroll after your initial enrollment period).
See the Eligibility and enrollment chapter for details.
Accidental death and
dismemberment
(AD&D) insurance
AD&D insurance
Naming a beneficiary
When your AD&D coverage begins
AD&D coverage amount
When AD&D benefits are paid
Additional AD&D benefits
Filing a claim
When benefits are not paid
Break in coverage
When coverage ends
If you leave the company and are rehired
If you drop or decrease your coverage and reenroll
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This information is intended to be a summary of your benefits and may not include all policy provisions. If
there is a discrepancy between this document and the policy issued by Prudential regarding the calculation
of benefits and limitations under the policy, the terms of the policy will govern. You may obtain a copy of
this policy by contacting the Plan.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Accidental death and dismemberment
(AD&D) insurance
AD&D benefits can help pay the cost of medical care, childcare, and education expenses if you’re
seriously injured or die in an accident.
RESOURCES
Find What You Need
Online
Other Resources
Change your beneficiary designation
Go to One.Walmart.com
Get more details
File a claim
Beneficiary changes cannot be made
over the phone
Call Prudential at 877-740-2116
Call Prudential at 877-740-2116
What you need to know about AD&D insurance
• If you are an hourly or management associate, you can enroll in AD&D insurance when you are eligible, as described
in the Eligibility and enrollment chapter.
• Proof of Good Health is not required for AD&D insurance, regardless of the coverage amount you choose.
• If you have a covered loss, AD&D insurance pays a lump sum benefit based on the nature of the loss and the coverage
amount you select. Additional benefits may be payable, depending on the circumstances of the covered loss.
• Coverage is provided through The Prudential Insurance Company of America (Prudential).
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AD&D insurance
AD&D insurance pays a lump sum benefit to you or your
beneficiary(ies) if you or a covered dependent experiences
a covered loss. The amount of your benefit depends on the
type of loss you experience, as described later in this chapter.
If you are an hourly or management associate, you can
enroll in AD&D insurance when you are eligible, as described
in the Eligibility and enrollment chapter. For details about
eligible job classifications, see the Enrollment and effective
dates by job classification charts in that chapter.
You have two AD&D coverage decisions. You choose whom
you want to cover and your coverage amount.
You can choose to cover:
• Associate only
• Associate + dependents
If you are a part‑time hourly associate, temporary associate,
or part‑time truck driver and you choose associate +
dependents coverage, you can cover your dependent
children but not your spouse/partner.
The coverage amount for your dependents will be a
percentage of the coverage amount you choose for
yourself (see AD&D coverage amount later in this chapter).
The amounts available for you to choose as your associate
coverage amount are:
• $25,000
• $50,000
• $75,000
• $100,000
• $150,000
• $200,000
Management associates may also choose the following
additional coverage amounts:
• $300,000
• $500,000
• $750,000
• $1,000,000
Naming a beneficiary
To ensure that your AD&D benefit is paid according to
your wishes, you must name a beneficiary(ies). You may
do this by going to One.Walmart.com. Note that only
beneficiary designations made online are accepted. You
(the associate) will receive any benefits payable for your
covered dependents.
You can name anyone you wish. If the beneficiary(ies) you
list with Walmart differs from the beneficiary(ies) named
in your will, the list that Walmart has prevails. If you have
not designated a beneficiary(ies) under the AD&D benefit,
payment will be made to your surviving family surviving
family members as described under If you do not name a
beneficiary later in this chapter.
The following information is needed for each beneficiary:
• Name
• Current address and phone number
• Relationship to you
• Social Security number
• Date of birth, and
• The percentage you wish to designate per beneficiary,
up to 100%.
If two or more beneficiaries are designated and their shares
are not specified, they will share the insurance benefit equally.
If a named beneficiary dies before you, that beneficiary’s
interest will end, and it will be shared equally by any remaining
beneficiary(ies), unless your beneficiary form states otherwise.
You can name a minor as a beneficiary; however, Prudential
may not be legally permitted to pay the minor until the minor
reaches legal age. You may want to consult an attorney or an
estate planner before naming a minor as a beneficiary. If you
name a minor as a beneficiary, funeral expenses cannot be
paid from the minor’s beneficiary proceeds.
CHANGING YOUR BENEFICIARY
You can enroll in or make changes to your AD&D insurance
during your initial enrollment period, Annual Enrollment,
or when you have a status change event. For more
information, see the Eligibility and enrollment chapter.
You can change your beneficiary(ies) at any time on
One.Walmart.com. Any change in beneficiary must be
completed and submitted to Walmart before your death and
can be submitted only by you, the covered associate.
The cost of AD&D insurance is based on the coverage
amount you select and whether you choose associate‑only
or associate + dependents coverage.
Be sure to keep your beneficiary information
up to date. Proceeds go to whoever is listed
on your beneficiary form with Walmart,
regardless of your current relationship with
that person, unless state law says otherwise.
You can change your beneficiary(ies) at any
time on One.Walmart.com.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
IF YOU DO NOT NAME A BENEFICIARY
If no beneficiary is named or there is no surviving
beneficiary at the time of your death, payment will be
made to surviving family members in the following order:
1. Spouse or partner of the deceased; if not surviving, then
2. Children in equal shares; if not surviving, then
3. Parents in equal shares; if not surviving, then
4. Siblings in equal shares, if not surviving, then
5. Your estate.
When your AD&D coverage begins
If you enroll during Annual Enrollment, your coverage
becomes effective on January 1 of the next year.
If you enroll outside of Annual Enrollment, your coverage
becomes effective on the date of the status change event or
the end of your eligibility waiting period, whichever is later.
Your AD&D coverage begins when you have enrolled for
the benefit and are actively at work. For AD&D coverage,
“actively at work” means you are on active status and have
reported for your first day of work, even if you are not at
work the day coverage begins (for example, due to illness).
See the Eligibility and enrollment chapter for details.
AD&D coverage amount
When you enroll in AD&D insurance, the coverage amount
you select is the amount that applies to you, the associate.
If you enroll in associate + dependent(s) coverage, the
coverage amount for your dependent(s) is a percentage of
your associate coverage amount. The coverage amount for
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your dependent(s) depends on the type of dependents you
are covering. See the Full benefit amount chart below for
information on the coverage amount for your family members.
When AD&D benefits are paid
If you have chosen associate + dependent(s) coverage and
you or your dependent sustains an accidental injury that is
the direct and sole cause of a covered loss, AD&D benefits
are paid when proof of the accidental injury and covered
loss have been properly provided to Prudential.
Prudential deems a loss to be the direct result of an
accidental injury if it results from unavoidable exposure
to the elements.
“Direct and sole cause” means the covered loss occurs within
12 months of the date of the accidental injury and is a direct
result of the accidental injury, independent of other causes.
COVERED LOSSES PAID AT FULL BENEFIT
The following covered losses resulting from an accident are
payable at the full benefit:
• Loss of life: It will be presumed that you have suffered
a loss of life if your body is not found within one year of
disappearance, stranding, sinking, or wrecking of any
vehicle in which you were an occupant.
• Loss of both hands above the wrists; both feet above the
ankles; total and permanent loss of sight in both eyes; loss
of speech and hearing in both ears that lasts for at least six
consecutive months following the accident.
• Loss of one hand and one foot: Severance at or above the
wrist and ankle joints.
• Loss of one arm or one leg: Severance at or above the
elbow or above the knee.
FULL BENEFIT AMOUNT
Associate coverage
amount
If a spouse/partner is the
only dependent covered
If both a spouse/partner and children are
covered dependents
If children are the
only dependents
Associate — 100%
Spouse/partner — 50%
Spouse/partner — 40%
Children — 10%
Children — 25%
$25,000
$50,000
$75,000
$100,000
$150,000
$200,000
$12,500
$25,000
$37,500
$50,000
$75,000
$100,000
Management associates only:
$300,000
$500,000
$750,000
$1,000,000
$150,000
$250,000
$375,000
$500,000
$10,000
$20,000
$30,000
$40,000
$60,000
$80,000
$120,000
$200,000
$300,000
$400,000
$2,500
$5,000
$7,500
$10,000
$15,000
$20,000
$30,000
$50,000
$75,000
$100,000
$6,250
$12,500
$18,750
$25,000
$37,500
$50,000
$75,000
$125,000
$187,500
$250,000
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• Loss of one hand or foot and sight in one eye: Severance at
or above the wrist or ankle joint, with total and permanent
loss of sight in one eye.
dependent remains comatose beyond 11 months, the full
sum of the coverage, less any AD&D benefit already paid,
is made to you or your designated beneficiary.
• Quadriplegia: Total paralysis of both upper and lower limbs.
• Paraplegia: Total paralysis of both lower limbs.
• Hemiplegia: Total paralysis of upper and lower limbs on one
side of the body.
50% OF FULL BENEFIT
The following covered losses resulting from an accident are
payable at 50% of full benefit:
• Brain damage: Brain damage means permanent and
irreversible physical damage to the brain, causing the
complete inability to perform all the substantial and
material functions and activities normal to everyday life.
Such damage must manifest itself within 30 days of the
accidental injury, require a hospitalization of more than
five consecutive days within 30 days of the accident, and
continue for 12 consecutive months.
• Loss of hand or foot: Severance at or above the wrist
or ankle.
• Loss of sight in one eye: Total and permanent loss of sight
in one eye.
• Loss of speech or hearing in both ears: Total and
permanent loss of speech or hearing (i.e., continuing for at
least six consecutive months following the accident).
25% OF FULL BENEFIT
The following covered losses resulting from an accident are
payable at 25% of full benefit:
• Loss of hearing in one ear: Total and permanent loss of
hearing (i.e., continuing for at least six consecutive months
following the accident).
• Loss of thumb and index finger of the same hand:
Severance at or above the point at which they are attached
to the hand.
• Uniplegia: Total paralysis of one limb.
“Paralysis” means loss of use, without severance, of a limb.
A doctor must determine that the loss is complete and not
reversible. “Severance” means complete separation and
dismemberment of the limb from the body.
COMA BENEFIT
If you or a covered dependent is comatose or becomes
comatose within 365 days as the result of an accident, a
coma benefit equal to 1% of your full benefit amount is paid
for 11 consecutive months to you, your spouse/partner, your
children, or a legal guardian. The benefit is payable after
31 consecutive days of being comatose. If you or a covered
“Coma” means a profound state of unconsciousness from
which the comatose person cannot be aroused, even by
powerful stimulation, as determined by the person’s doctor.
Such state must begin within 365 days of the accidental
injury and continue for 31 consecutive days and is total,
continuous, and permanent at the end of the 31‑day period.
The maximum amount that AD&D insurance will pay for all
covered losses of an individual resulting from a covered
accident is the full benefit amount.
Additional AD&D benefits
Additional benefits may be payable by the Plan:
• Seat belt benefit: If you and/or your covered dependents
suffer a loss of life as a result of a covered accident that
occurs while wearing a seat belt, an additional benefit
may be payable.
• Safe motorcycle rider benefit: If you and/or your covered
dependents suffer a loss of life as a result of a covered
accident that occurs while wearing a helmet, an additional
benefit may be payable.
• Spouse/partner education benefit (full‑time hourly and
management associates only): If you (the associate)
suffer a loss of life, a spouse/partner education benefit
may be payable.
• Child education and care benefit: If you (the associate)
or your covered spouse/partner suffers a loss of life,
a childcare benefit and/or child education benefit
may be payable.
• Home alteration and vehicle modification benefit: If
you or your covered dependents suffer a covered loss
that requires home alteration or vehicle modification,
an additional benefit may be payable.
• COBRA monthly medical premium benefit: If you (the
associate) suffer a covered accidental bodily injury which
results in your death or a termination after a leave of
absence, an additional benefit may be payable to assist
with the continuation of medical benefits under the
Associates’ Medical Plan.
• Monthly rehabilitation benefit: If you or your covered
dependents suffer a covered accidental bodily injury that
requires medically necessary rehabilitation, an additional
benefit may be payable.
• Common accident benefit: If you (the associate) or your
covered spouse/partner both suffer a loss of life due to the
same accident or accidents that occur within 48 hours of
each other, a common accident benefit may be payable.
All additional AD&D benefits are subject to eligibility
criteria established by Prudential. Contact Prudential for
information if any of these benefits might apply to you.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
ADDITIONAL BENEFITS
Benefit
Benefit amount
Limitations
Seat belt benefit
$10,000
Safe motorcycle
rider benefit
$10,000
If it cannot be determined that the person was wearing a
seat belt at the time of the accident, a benefit of $1,000
will be paid.
If it cannot be determined that the person was wearing
the necessary safety equipment at the time of the
accident, a benefit of $1,000 will be paid.
Education benefit
for spouse/partner
An amount equal to the least of:
• The actual tuition charged for the program;
• 10% of your (the associate’s) amount of
Payable for up to 4 years.
Full-time hourly and management associates only.
insurance; and
• $25,000
Education benefit
for child
An amount equal to the least of:
• The actual annual tuition, exclusive of room
Payable annually for up to 4 consecutive years, but not
beyond the date the child reaches age 26.
and board, charged by the school;
• 10% of the amount of insurance on the
person incurring the loss; and
• $25,000
Childcare benefit
An amount equal to the least of:
• The actual cost charged by a childcare
Payable annually for up to 5 consecutive years, but not
beyond the date the child reaches age 13.
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center per year;
• 10% of the amount of insurance on the
person incurring the loss; and
• $12,500
An amount equal to the least of:
• The actual cost charged for the alteration or
modification;
• 10% of the amount of insurance on the
person incurring the loss; and
• $10,000
An amount equal to the least of:
• The amount of the medical premium;
• 5% of your (the associate’s) amount of
insurance; and
• $500
An amount equal to the lesser of:
• The actual amount of the medical premium;
and
• $10,000
Home alteration
and vehicle
modification
benefit
Medical premium
benefit for
associate
(COBRA)
Medical premium
benefit for
dependent
(COBRA)
Payable for an amount no greater than $10,000.
Payable monthly until the first of these occurs:
• Your continued enrollment in the AMP ends
• You become covered under any other group medical plan
• The benefit has been paid for 36 consecutive months
Payable yearly until the first of these occurs:
• Your dependent’s continued enrollment in the AMP ends
• Your dependent becomes covered under any other
group medical plan
• The benefit has been paid for 3 consecutive years.
A benefit for spouse/partner premiums is only available to
full-time hourly and management associates only.
Monthly
rehabilitation
benefit
An amount equal to the lesser of:
• 10% of the amount of insurance on the
Payable monthly until the first of these occurs:
• A doctor determines the person no longer needs
person incurring the loss; and
rehabilitation
• $250
• The person fails to furnish any required proof of a
continuing need for rehabilitation
• The person fails to submit to a required medical exam
• The benefit has been paid for 36 consecutive months
Common accident
benefit
An amount equal to the difference between:
• The amount of insurance payable under the
coverage for your loss of life; and
• The amount of insurance payable under
the coverage for your spouse or domestic
partner’s loss of life
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Filing a claim
The following information must be provided to Prudential
regarding the claimant:
• Name
• Social Security number
• Date of death or injury, and
• Cause of death or injury (if known).
Prudential will send a claim packet to your address on file.
The required information must be completed and returned
with the claim forms and an original or certified copy of the
death certificate, when applicable, to:
The Prudential Insurance Company of America
Group Claim Life Division
P.O. Box 8517
Philadelphia, Pennsylvania 19176
Benefits are paid in a lump sum. If you or a covered
dependent sustains more than one covered loss due to an
accidental injury, the amount paid, on behalf of any such
injured person, will not exceed the full amount of the benefit.
Claims are determined under the time frames and
requirements set out in the Claims and appeals chapter. You
or your beneficiary has the right to appeal a claim denial.
When benefits are not paid
AD&D benefits are not paid for any loss that occurs prior
to your enrollment in the Plan, nor any loss caused or
contributed to by the following:
• Suicide or attempted suicide, while sane or insane
• Intentionally self‑inflicted injuries, or any attempt to inflict
such injuries
• Sickness, whether the loss results directly or indirectly
from the sickness
• Medical or surgical treatment of sickness, whether the loss
results directly or indirectly from the treatment
• Bacterial or viral infection, but not including:
– Pyogenic infection resulting from an accidental cut or
wound, or
– Bacterial infection resulting from accidental ingestion
of a contaminated substance.
• Taking part in any insurrection
• War, declared or undeclared, or any act of war
• An accident that occurs while the person is serving on
full‑time active duty for more than 30 days in any armed
forces (not including Reserve or National Guard active
duty for training)
• Travel or flight in any vehicle used for aerial navigation if
you are riding as a passenger in any aircraft not intended
or licensed for the transportation of passengers (including
getting in, out, on, or off such vehicle)
• Commission or attempted commission of an assault
or felony
• Operating a land, water, or air vehicle while being legally
intoxicated, or
• Being under the influence of or taking any controlled
substance as defined in Title II of the Comprehensive
Drug Abuse Prevention and Control Act of 1970, and
all amendments, unless prescribed by and administered
in accordance with the advice of the insured’s doctor.
Break in coverage
There may be occasions in which you must make special
arrangements to pay your AD&D insurance premiums to
avoid a break in coverage. These situations occur most
commonly if you are on a leave of absence or if your
Walmart paycheck is not sufficient to pay your full share of
the cost of coverage (such as after a reduction in hours).
Failure to make your premium payments by the due date
may result in an interruption in the payment of any benefit
claims and/or a break in coverage.
For details on the impact a break in coverage may have,
and on how to make personal payments to continue your
coverage, see When special arrangements are necessary to
maintain coverage in the Eligibility and enrollment chapter.
IF YOU GO ON A LEAVE OF ABSENCE
You may continue your coverage up to the last day of an
approved leave of absence, provided that you pay your
premiums before or during the leave. For information
about making payments while on a leave of absence, see
When special arrangements are necessary to maintain
coverage in the Eligibility and enrollment chapter.
When coverage ends
Your AD&D coverage ends:
• At termination of your employment
• On the last day of coverage for which premiums were paid,
if you fail to pay your premiums within 30 days of the date
your premium is due
• On the date of your death
• On the date you or a dependent spouse/partner or child
loses eligibility
• On the last day of an approved leave of absence (unless
you return to work), or
• When the benefit is no longer offered by the company.
AD&D coverage cannot be converted to individual
coverage after coverage ends.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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In addition, if you have chosen associate + dependent(s)
coverage and your job status changes to part‑time hourly
associate, temporary associate, or part‑time truck driver,
your coverage for your spouse/partner will end on the last
day of the pay period when your job status changes.
If you voluntarily drop coverage after a status change event
or at Annual Enrollment, coverage ends as follows:
• After a status change event: coverage ends on the
effective date of the event. See Status change events in
the Eligibility and enrollment chapter for information.
• At Annual Enrollment: coverage ends on December 31 of
the current year.
If you leave the company and
are rehired
If you return to work for the company within 13 weeks, you
will automatically be reenrolled for the same coverage in
effect prior to leaving the company (or the most similar
coverage offered under the Plan). If your break is greater
than 30 days but less than 13 weeks, you will have 60 days
after resuming employment to drop or otherwise change
the coverage in which you were automatically reenrolled.
If you return to work after 13 weeks, you will be considered
newly eligible and will be required to complete the
applicable eligibility waiting period.
See the Eligibility and enrollment chapter for details.
If you drop or decrease your
coverage and reenroll
If you drop or decrease your coverage and reenroll within
30 days, you may reenroll for the same coverage in effect
prior to dropping or decreasing coverage.
If you reenroll more than 30 days after dropping or
decreasing coverage, you may enroll for coverage under the
time periods and conditions described in the Eligibility and
enrollment chapter.
IF A DEPENDENT IS DROPPED FROM
COVERAGE AND REENROLLED
If your dependent child is dropped from coverage and then
determined to be eligible for coverage within 30 days, the
dependent will automatically be reenrolled in the same
coverage you elect for yourself.
If your dependent regains eligibility and is reenrolled after
30 days, they will be treated as a newly eligible dependent.
The associate may enroll them for coverage under the
time periods and conditions described in the Eligibility and
enrollment chapter.
Business travel
accident insurance
Business travel accident insurance
Naming a beneficiary
Filing a claim
When benefits are paid
Additional benefits
When benefits are not paid
When coverage ends
If you leave the company and are rehired
International business travel medical insurance
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This information is intended to be a summary of your benefits and may not include all policy provisions. If
there is a discrepancy between this document and the policies issued by the applicable insurers under this
chapter regarding the calculation of benefits and limitations under the policies, the terms of the policies will
govern. You may obtain a copy of these policies by contacting the Plan.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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Business travel accident insurance
When you’re traveling on authorized company business, this insurance protects you and your
loved ones financially if you have an accident resulting in certain types of injury or death.
RESOURCES
Find What You Need
Online
Other Resources
Change your beneficiary designation
Go to One.Walmart.com
Get more details
File a business travel accident insurance claim
Get more details about international business
travel medical insurance through GeoBlue
Go to geo-blue.com
Beneficiary changes cannot be made
over the phone
Call Prudential at 877-740-2116
Call Prudential at 877-740-2116
Call GeoBlue at 888-412-6403
Outside the U.S. call 610-254-5830
What you need to know about business travel accident insurance
• Walmart provides all associates with business travel accident insurance. There is no cost to you and no enrollment
is necessary.
• Business travel accident insurance pays a benefit for loss of life, limb, sight, speech and hearing, or paralysis, due to an
accident you are involved in while traveling on authorized company business.
• Your coverage amount for accidents while traveling is three times your base annual earnings to a maximum of $1 million.
• This company‑paid insurance is provided through The Prudential Insurance Company of America (Prudential).
• International business travel medical insurance is available for eligible business travelers through GeoBlue.
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Business travel accident insurance
To protect you while you travel on company business,
Walmart provides all associates with business travel accident
insurance. There is no cost to you and no enrollment is
necessary. Coverage is effective on your first day of
active work. You are considered actively at work if you are
on active status and not on a leave of absence. See the
Eligibility and enrollment chapter for details.
If you experience a covered injury resulting in loss or
death while traveling on authorized company business, a
lump‑sum benefit is payable to you or your beneficiary(ies)
of up to three times your base annual earnings, with a
maximum of $1 million and minimum of $200,000 (unless
otherwise specified).
Base annual earnings is defined as follows:
• For hourly associates: Annualized hourly rate as shown in
the Walmart payroll system as of date of loss or death.
• For management associates and officers: Base salary as
shown in the Walmart payroll system as of date of loss
or death.
• For truck drivers: Annualized average day’s pay as of date
of loss or death, as determined by Logistics Finance.
Note that any bonus you may receive is not included in base
annual earnings.
Naming a beneficiary
To ensure that your business travel accident insurance
benefit is paid according to your wishes, you must
name a beneficiary(ies). You may do this by going to
One.Walmart.com. Note that only beneficiary designations
made online are accepted. You (the associate) will receive
any benefits payable for the injuries listed in When
business travel accident insurance benefits are paid later in
this chapter.
You can name anyone you wish. If the beneficiary(ies) you
list with Walmart differs from the beneficiary(ies) named
in your will, the list that Walmart has prevails. If you have
not designated a beneficiary(ies) under the business travel
accident benefit, payment will be made to your surviving
family members as described under If you do not name a
beneficiary later in this chapter.
The following information is needed for each beneficiary:
• Name
• Current address and phone number
• Relationship to you
• Social Security number
• Date of birth, and
If two or more beneficiaries are designated and their
shares are not specified, they will share the insurance
benefit equally. If a named beneficiary dies before you, that
beneficiary’s interest will end, and it will be shared equally
by any remaining beneficiary(ies), unless your beneficiary
form states otherwise. If you and a beneficiary die in the
same event and it cannot be determined who died first,
the beneficiary will be treated as having died before you.
You can name a minor as a beneficiary; however, Prudential
may not be legally permitted to pay the minor until the
minor reaches legal age. You may want to consult an
attorney or an estate planner before naming a minor as a
beneficiary. If you name a minor as a beneficiary, funeral
expenses cannot be paid from the minor’s beneficiary
proceeds.
CHANGING YOUR BENEFICIARY
You can change your beneficiary(ies) at any time on
One.Walmart.com. Any change in beneficiary must be
completed and submitted to Walmart before your death
and can be submitted only by you, the covered associate.
IF YOU DO NOT NAME A BENEFICIARY
If no beneficiary is named or there is no surviving
beneficiary at the time of your death, payment will be made
to your surviving family members in the following order:
1. Spouse or partner of the deceased; if not surviving, then
2. Children in equal shares; if not surviving, then
3. Parents in equal shares; if not surviving, then
4. Siblings in equal shares; if not surviving, then
5. Your estate.
Be sure to keep your beneficiary information
up‑to‑date. Proceeds will go to whoever is
listed on your beneficiary form with Walmart,
regardless of your current relationship with
that person, unless state law says otherwise.
You can change your beneficiary(ies) at any
time on One.Walmart.com.
Filing a claim
Within 12 months of the covered associate’s injury or death
or within 90 days after any periodic payment is due (such
as periodic payments for coma), the following information
must be provided regarding the associate:
• Name
• Social Security number
• The percentage you wish to designate per beneficiary,
up to 100%.
• Occurrence, character, and extent of the injury
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• Date of injury or death, and
• Cause of injury or death (if known).
An original or certified copy of the death certificate is
required as proof of death. The death certificate should be
mailed to:
The Prudential Insurance Company of America
Group Life Claim Division
P.O. Box 8517
Philadelphia, Pennsylvania 19176
The claim will not be finalized until Prudential receives the
death certificate, where applicable. Acceptance of the
death certificate is not a guarantee of payment.
Benefits can be paid in a lump sum or, upon written request,
in monthly installments. Only one benefit, the highest, will
be paid if you suffer more than one loss resulting from a
single accident.
Claims are determined under the time frames and
requirements set out in the Claims and appeals chapter.
Your beneficiary(ies) has the right to appeal a claim denial.
Benefits are paid according to the terms of the insurance
policy. For details, contact Prudential at 877-740-2116.
When benefits are paid
Benefits are paid if you sustain an accidental injury while
traveling on authorized company business or due to a
felonious assault while you are working; your injuries
are the direct and sole cause of a covered loss; and you
properly provide proof of the accidental loss and covered
loss to Prudential.
Traveling for business includes travel using a common
carrier or any means of transportation owned and operated
by the company. An accidental injury includes exposure to
the elements. “Direct and sole cause” means the covered
loss occurs within 12 months of the date of the accidental
injury and is a direct result of the accidental injury,
independent of other causes.
BENEFIT AMOUNT
COVERED INJURY OCCURS…
BENEFIT AMOUNT
While traveling on authorized
company business
Due to a felonious assault while
you are working
Three times your
base annual earnings
to a maximum of
$1,000,000
Minimum benefit:
$200,000
Up to $10,000
COVERED LOSSES PAID AT FULL BENEFIT
• Quadriplegia: Total paralysis of both upper and lower limbs.
• Paraplegia: Total paralysis of both lower limbs.
• Hemiplegia: Total paralysis of upper and lower limbs on one
side of the body.
• Loss of both hands, both feet, or sight in both eyes:
Severance through or above both wrists or both ankle
joints, or total and irrecoverable loss of sight.
• Loss of one hand and one foot: Severance through or
above the wrist or ankle joint.
• Loss of speech and hearing in both ears: Total loss of
speech and hearing that lasts for at least six consecutive
months following the accident.
• Loss of hand or foot and sight in one eye: Severance
through or above the wrist or ankle joint, with total and
irrecoverable loss of sight in one eye.
50% OF FULL BENEFIT
• Loss of hand or foot: Permanent severance through
or above the wrist but below the elbow, or permanent
severance at or above the ankle but below the knee.
• Brain damage: Brain damage means permanent and
irreversible physical damage to the brain, causing the
complete inability to perform all of the substantial
and material functions and activities of everyday life.
Such damage must manifest itself within 30 days of the
accidental injury, require hospitalization of at least five
days and persist for 12 consecutive months.
• Loss of sight in one eye: Total and permanent loss of sight
in one eye.
• Loss of speech or hearing in both ears: Total loss of speech
or hearing that lasts for at least six consecutive months
following the accident.
25% OF FULL BENEFIT
• Loss of thumb and index finger of the same hand:
Severance of each through or above the joint closest to
the wrist.
• Uniplegia: Total paralysis of one limb.
“Paralysis” means loss of use, without severance, of a limb.
A doctor must determine that the loss is complete and not
reversible. (“Severance” means complete separation and
dismemberment of the limb from the body.)
COMA BENEFIT
If you are comatose or become comatose within 365 days
as the result of a covered accident, a monthly coma benefit
equal to the greater of 2% of your full benefit amount or
$100 is paid for up to 50 months. The benefit is payable
after 31 consecutive days of being comatose.
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“Coma” means a profound state of unconsciousness from
which the comatose person cannot be aroused, even by
powerful stimulation, as determined by the person’s doctor.
Such state must begin within 365 days of the accidental
injury and continue for 31 consecutive days and is total,
continuous, and permanent at the end of the 31‑day period.
The maximum amount the business travel accident
insurance will pay you for all covered losses resulting from
a covered accident is the full benefit amount. If more than
one associate suffers a loss as a result of the same accident,
the maximum the business travel accident insurance policy
will pay for all losses is $10 million per accident and, if
necessary, benefits will be prorated among the affected
associates suffering a loss in the accident. The maximum
total payment is increased to $20 million if the covered
accident occurs while you are traveling to or from, or while
you are attending, Walmart’s Annual Shareholders Meeting,
annual holiday meeting, or annual year beginning meeting.
Additional benefits
Business travel accident insurance provides these
additional benefits:
• Seat belt benefit: If you suffer a loss of life as a result of a
covered accident that occurs while wearing a seat belt, an
additional benefit of up to $10,000 may be payable.
When benefits are not paid
Business travel accident insurance benefits will not be paid
for for any loss that results from any of the following:
• Suicide or attempted suicide, while sane or insane
• Intentionally self‑inflicted injuries, or any attempt to inflict
such injuries
• Sickness, whether the loss results directly or indirectly
from the sickness
• Medical or surgical treatment of sickness, whether the loss
results directly or indirectly from the treatment
• Any bacterial or viral infection, except a pyogenic
infection resulting from an accidental cut or wound or a
bacterial infection resulting from accidental ingestion of a
contaminated substance
• War or act of war (declared or undeclared), including
resistance to armed aggression or an accident while on
full‑time active duty with the armed services for more than
30 days (this does not include Reserve or National Guard
active duty for training)
• Riding in an unlicensed aircraft
• Flying as a crew member of an airplane, except one owned
and operated by the company
• Commission or attempted commission of an assault
or felony
• Airbag benefit: If you suffer a loss of life as a result of a
• Operating a land, water, or air vehicle while being legally
covered accident that occurs while you are wearing a seat
belt and a properly functioning airbag deploys in the seat
you were occupying, an additional benefit of up to $10,000
may be payable.
• Funeral expenses benefit: If you suffer a loss of life within
365 days of and as a result of a covered accident, an
additional benefit of up to $5,000 may be payable.
• Medical evacuation benefit: If, as a result of a covered
accident, you require medical evacuation and are at least
100 miles from your home, an additional benefit of up to
$15,000 may be payable.
• Family relocation and accompaniment: If your spouse or
partner or dependent child suffers a covered loss while
traveling with you on business (or while on their way to
meet you), an additional benefit of up to $100,000 may be
payable for losses sustained by your spouse or partner, and
$10,000 for losses sustained by each dependent child.
All of these additional benefits are subject to additional
eligibility criteria established by Prudential. Please
contact Prudential if any of these benefits might apply for
additional information.
intoxicated, or
• Being under the influence of or taking any controlled
substance as defined in Title II of the Comprehensive
Drug Abuse Prevention and Control Act of 1970, and all
amendments, unless prescribed by and administered in
accordance with the advice of the insured’s doctor.
When coverage ends
Your business travel accident insurance coverage ends on
your last day of employment.
If you leave the company and
are rehired
Your business travel accident insurance coverage
(or the most similar coverage offered under the Plan)
will be reinstated.
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Associates are advised to register on geo-blue.com
before their business travel, using group access code
QHG99999WALM. By registering, you gain access to
services and benefits including:
• Ability to print out your insurance ID card in case yours
is lost
• Doctor/facility locator
• Symptom checker
• Translate medical terms and medications, and
• Information about health and security risks.
Downloading the GeoBlue app: Once you’ve registered,
download the GeoBlue app and log in with the email address
and password you create when you register on the website.
The app provides you with convenient access to your ID
card and GeoBlue’s self‑service tools including mapping
to your nearest approved medical facility/provider, making
appointments, etc.
GeoBlue member ID cards: Cards carry the Blue Cross Blue
Shield logo and are available in your travel department.
Additional or replacement cards can be downloaded via
geo-blue.com.
Claims: Claim forms are generally not required for GeoBlue
services. However, if you have a question about your
benefits or disagree with the benefits provided, you may
contact GeoBlue or file a claim. To submit a claim via email
or fax, download a claim form and view detailed instructions
in the Member Hub at geo-blue.com. Submit your claim by
email to claims@geo-blue.com or by fax to 610-482-9623.
You may also submit claims by post. Download a claim form
from the Member Hub at geo-blue.com and send your
completed form to:
GeoBlue
Claims Department
P.O. Box 1748
Southeastern, Pennsylvania 19399-1748
Claims and appeals are determined under the time frames
and requirements set out in the GeoBlue policy. Contact
GeoBlue at any time by calling 888-412-6403. Outside the
U.S. call collect: 610-254-5830.
International business travel
medical insurance
International business travel medical insurance is available
through a policy with GeoBlue for associates who travel
internationally for business.
GeoBlue provides travel assistance services to you and
your eligible dependents if you require emergency medical
treatment while traveling on company‑authorized business.
Walmart pays for this coverage in full — there is no cost
to you and no enrollment is necessary. Coverage is valid
for a trip lasting up to 180 days. Coverage is not available
for personal travel even when you add personal travel to a
business trip.
You are not eligible to make health savings account
contributions for any month in which you are traveling
on Walmart business outside the U.S. and are covered
under the GeoBlue policy. If you have medical coverage
under the Saver Plan, you are encouraged to consult
with your tax advisor if you have questions about the
amount to reduce your HSA contributions based on your
individual circumstances.
GEOBLUE SERVICES
Business travel medical insurance through GeoBlue provides
coverage for emergency medical treatment including
hospitalization, doctor visits, and prescription drug
coverage (not including over‑the‑counter medication).
GeoBlue has a network of doctors, physicians, and
medical facilities in over 180 countries and can also make
appointments on your behalf and arrange for direct billing.
Associates are advised to contact GeoBlue Customer
Service at 888-412-6403 before obtaining medical
treatment to ensure that the treatment is covered.
GeoBlue provides the following services:
• Reimbursement for eligible medical expenses
• Assistance in location of physician, medical facilities, and
making medical appointments
• Direct billing and payment guarantees
• Coordination for emergency medical evacuation to the
nearest appropriate medical facility for the associate and
an accompanying family member(s), and
• Repatriation of remains.
If you incur eligible medical expenses, submit them to
GeoBlue for reimbursement. They should not be charged to
the corporate credit card or submitted for reimbursement
through the travel and expense system.
Full-time hourly
short-term disability
Full‑time hourly short‑term disability
How short‑term disability benefits are funded
How the Walmart short‑term disability benefit is administered
Your short‑term disability benefit
When you qualify for benefits
When benefits are not paid
Filing a claim
When benefits begin
Calculating your benefit
When short‑term disability benefit payments end
Returning to work
Coverage during a leave of absence or temporary layoff
When coverage ends
If you leave the company and are rehired
If you lose and then regain eligibility or drop coverage and reenroll
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Full-time hourly short-term disability
If pregnancy, a scheduled surgery, or an unexpected illness or injury keeps you off the job for an
extended period, this plan for full‑time hourly associates can protect part of your paycheck. When
you can’t work, the Walmart short‑term disability plan works for you.
RESOURCES
Find What You Need
Online
Other Resources
To request a leave
Go to One.Walmart.com/LOA > mySedgwick Call Sedgwick at 800-492-5678
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Go to One.Walmart.com/LOA > mySedgwick Call Sedgwick/Lincoln at 800-492-5678
Except as provided below, to file a basic
or enhanced claim, file a maternity
benefit claim, or get more information
To file a benefit claim or get more
information if you work in any of the
following areas:
California
Connecticut
Massachusetts
Rhode Island
Washington, D.C.
Washington State
Go to edd.ca.gov
Go to ctpaidleave.org
Go to paidleave.mass.gov
Go to www.dlt.ri.gov/tdi
Go to dcpaidfamilyleave.dc.gov
Go to paidleave.wa.gov
Call 800-480-3287
Call 833-344-7365
Call 401-462-8420
Call 202-899-3700
Call 833-717-2273
What you need to know about full-time hourly short-term disability
• If you are an eligible full‑time hourly associate, Walmart offers the short‑term disability basic plan at no cost to you. If eligible,
you will be automatically enrolled in the plan and coverage will be effective after your 12‑month waiting period. However,
if you are a full‑time hourly vision center manager, you are automatically enrolled in the short‑term disability basic plan
and coverage is effective as of your date of hire. If you are a full‑time hourly vision center manager, please disregard any
reference to a 12‑month waiting period for short‑term basic plan coverage as you review this chapter, unless stated otherwise.
• During your initial enrollment period, you can also enroll in the short‑term disability enhanced plan and coverage will be
effective after a 12‑month waiting period. If you are a full‑time hourly vision center manager and you enroll in timely manner in
coverage under the short‑term disability enhanced plan during your initial enrollment period, your coverage will be effective as
of your date of hire (please disregard any reference to an initial 12‑month waiting period for enhanced coverage as you review
this chapter, unless stated otherwise). If you enroll in the short‑term disability enhanced plan at any time other than during your
initial enrollment period, coverage will not be effective until you complete a 12‑month waiting period. This 12‑month waiting
period for delayed enrollment in the short‑term disability enhanced plan applies to all full‑time hourly associates, including
full‑time vision center managers. For details about your enrollment period, see the Eligibility and enrollment chapter.
• If you are a full‑time hourly associate who works in California, Hawaii, New Jersey, or Rhode Island, which have legally
mandated plans, you are not eligible for Walmart’s short‑term disability coverage unless you are making a claim for maternity
leave benefits.
• In addition to the states named above, certain other states and local governments (currently Connecticut, Massachusetts,
New York, Washington, D.C. and Washington State) also have legally mandated plans, but Walmart extends short‑term
disability coverage options to full‑time hourly associates in these other states and localities in order to supplement their state
disability benefits.
• The short‑term disability basic plan replaces 50% of your average weekly wage, with no weekly maximum (if you work in New
York there is a maximum of $6,000 per week). The short‑term disability enhanced plan replaces 60% of your average weekly
wage with no weekly maximum (the New York short‑term disability enhanced plan has a maximum of $6,000 per week).
• If your disability is due to pregnancy, the short‑term disability plan maternity benefit replaces 100% of your average weekly
wage. For details, see Maternity benefit later in this chapter.
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Full-time hourly short-term disability
If you are an eligible full‑time hourly associate, you are
automatically enrolled in the short‑term disability basic
plan and, provided you are actively at work, coverage will
be effective after your 12‑month waiting period. You also
have the opportunity to enroll in the short‑term disability
enhanced plan. For details about your enrollment period
and the 12‑month waiting period, see the Eligibility and
enrollment chapter.
If you are a full‑time hourly associate who works in California,
Hawaii, New Jersey, or Rhode Island, which have legally
mandated disability plans, you are not eligible for the
short‑term disability basic plan or enhanced plan, but you
are automatically enrolled in the short‑term disability plan
maternity benefit after a 12‑month waiting period, provided
you are actively at work on that day. See Legally mandated
plans below for details about coverage options available to
associates in states and localities with legally mandated plans.
How short-term disability benefits
are funded
The short‑term disability basic plan and the short‑term
disability plan maternity benefit are provided by the company
at no cost to you. No associate contributions are required
for the short‑term disability basic plan or the short‑term
disability plan maternity benefit. You and the company share
the cost of the short‑term disability enhanced plan. If you
participate in the short‑term disability enhanced plan, your
cost is based on your biweekly earnings and your age. Your
contributions are intended to cover the costs of benefits.
LEGALLY MANDATED PLANS
If you work in a state with a legally mandated plan, differences in laws and administrative procedures affect your eligibility to
participate in Walmart’s short‑term disability plans and the amount of your disability benefit. See below for general information.
Call the number listed in the Resources chart for details about benefits in these states. See Maternity benefit for information
about the separate maternity benefit, including information about administration.
Legally mandated and
administered plans
Legally mandated plans,
administered by Lincoln
Legally mandated plans,
administered by Sedgwick
California
Rhode Island
Associates in these states are not eligible to participate in Walmart’s short‑term disability plans
for hourly associates. Their benefit is administered by the state.
Hawaii
New Jersey
Associates in these states are not eligible to participate in the short‑term disability basic or
enhanced plan for hourly associates. Their benefit is provided in accordance with the state
program and administered by Lincoln.
New York
Associates in New York are eligible to participate in Walmart’s short‑term disability basic plan
and the New York short‑term disability enhanced plan to supplement their state benefit. Their
benefit is insured and administered by Lincoln.
All other states
Associates in other states and localities with legally mandated benefits are eligible to participate
in the short‑term disability basic and enhanced plans to supplement their state or local benefits,
which are administered by Sedgwick.
Associates who work in Connecticut, Massachusetts, Washington State, and Washington, D.C.
also have the opportunity to enroll in the short‑term disability enhanced plan to supplement
the benefits mandated by the state or locality. The amount of the benefit under the short‑term
disability plans will be reduced by the amount of the legally mandated benefit Sedgwick estimates
that you are eligible to receive from the state or locality, regardless of whether you apply for
that legally mandated benefit. The total benefits payable under the short‑term disability plan to
supplement your state or locality benefit will not exceed the level of benefits otherwise payable
under the plan. Upon request, you will be responsible for providing your award letter from the
state or locality to Sedgwick. If Sedgwick overestimated what your mandated benefit would be,
meaning that you were paid less under the short‑term disability plan than you were entitled to,
you will be paid the difference in a lump sum payment. If Sedgwick underestimated what your
mandated benefit would be, meaning that you were paid more under the short‑term disability
plan than you were entitled to, you must repay any amount overpaid to you. See The Plan’s
right to recover overpayment and The Plan’s right to salary/wage deduction in the Claims and
appeals chapter. If you do not repay overpaid amounts in a timely manner, the company will first
deduct such amounts from future disability payments (if any), then may treat the portion of such
amounts that were not taxed when paid as taxable wages to you (reportable on your Form W‑2) or,
alternatively, deduct such amounts from your paycheck, to the extent permitted by law.
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Except for associates in New York, the short‑term
disability basic plan and enhanced plan coverage, as well
as the maternity benefit, are self‑insured. This means no
insurance company collects premiums and pays benefits.
The company currently funds benefits under the short‑term
disability basic plan, as well as maternity benefits, by using
the company’s general assets.
For associates in New York, benefits provided under
the short‑term disability basic plan and the New York
short‑term disability enhanced plan are insured by Lincoln.
How the Walmart short-term
disability benefit is administered
In general, the short‑term disability plan (including basic,
enhanced and maternity benefits) is administered by
Sedgwick Claims Management Services, Inc. (Sedgwick).
With respect to any benefit payments made under the
short‑term disability plan, the Plan Administrator has
delegated the fiduciary authority to determine claims for
benefits and to decide related appeals to Sedgwick.
Details follow regarding the administration of non‑maternity
disability coverage available for associates in states and
localities with legally mandated plans. For details regarding
the administration of short‑term disability plan maternity
benefits, see Maternity benefit later in this chapter.
Your short-term disability benefit
If you are eligible and become disabled as defined by
the short‑term disability plan (see When you qualify for
benefits later in this chapter), the short‑term disability
basic plan provides up to 50% of your average weekly wage
for up to 25 weeks of an approved disability, after a waiting
period of seven calendar days, with no maximum weekly
benefit (if you work in New York there is a maximum
of $6,000 per week). For more information about your
average weekly wage, see Calculating your benefit later in
this chapter.
If you are eligible and become disabled as defined by the
short‑term disability plan and do not work in New York,
the short‑term disability enhanced plan provides up to
60% of your average weekly wage for up to 25 weeks of an
approved disability, after a waiting period of seven calendar
days, with no maximum weekly benefit. If you work in New
York, the New York short‑term disability enhanced plan
provides up to 60% of your average weekly wage for up
to 25 weeks after a waiting period of seven calendar days
if you become disabled as defined by the Plan, and has a
$6,000 maximum weekly benefit.
If you are eligible and your disability is due to pregnancy,
the short‑term disability plan pays a maternity benefit of
100% of your average weekly wage for the first nine weeks,
after an initial waiting period of seven calendar days. If
you are eligible for legally mandated short‑term disability
benefits, the short‑term disability plan maternity benefit
supplements your state benefits. If you remain disabled and
eligible for benefits after the first nine weeks of disability
pay, and you work in a location that is eligible to participate
in the company’s short‑term disability basic and enhanced
plans, the short‑term disability plan will pay the benefit
under the basic plan or enhanced plan, depending on which
plan you are enrolled in, for up to 16 additional weeks of
benefit payments.
You may use available paid time off (PTO) during the initial
waiting period of seven calendar days. Benefits under the
short‑term disability plan begin on the eighth calendar day
after your eligible disability begins. PTO may not be used
while any claim decision is pending or you are receiving
short‑term disability benefits. PTO utilized beyond the
waiting period of seven calendar days must be repaid.
ENROLLMENT FOR SHORT-TERM
DISABILITY BENEFITS
You are automatically enrolled in the short‑term disability
basic plan after a 12‑month waiting period. You must be
actively at work for your coverage to become effective.
Being actively at work means you have worked hours in the
immediately preceding pay period. If you are not actively
at work immediately following the end of your 12‑month
waiting period, you will be enrolled as of the first day of the
next pay period in which you have hours worked. See the
Eligibility and enrollment chapter for details.
If you work in a state or locality with legally mandated
benefits and are not eligible to participate in the company’s
short‑term disability basic or enhanced plans, you will
automatically become eligible for the short‑term disability
plan maternity benefit after a 12‑month waiting period,
subject to the actively‑at‑work requirement described above.
The effective date of your short‑term disability enhanced
plan coverage depends on when you enroll for coverage,
but will always follow a 12‑month waiting period. The specific
beginning and end date of the 12‑month waiting period
depends on whether you enroll during your initial enrollment
period, when you transfer to full‑time hourly status, during
Annual Enrollment, or when you have a status change
event. You are not required to pay premiums for short‑term
disability enhanced coverage during your 12‑month waiting
period. For information about the effective date and
applicable 12‑month waiting period that applies when you
enroll during or after your initial enrollment period, see the
Eligibility and enrollment chapter.
If you are enrolled in the short‑term disability enhanced
plan, you will be able to drop coverage only at Annual
Enrollment or after a status change event. If you later
reenroll, you will have to satisfy another 12‑month waiting
period, as described above.
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When you qualify for benefits
To qualify for short‑term disability benefits, you must meet
the following requirements:
• You have completed the 12‑month waiting period and your
coverage has become effective, subject to actively‑at‑
work requirements.
• Your disability must have occurred on or after the
effective date of your coverage.
• You must be actively at work (as defined above) at the time
of your disability unless:
– You are not actively at work in certain cases of leave
of absence or layoff, as described later in this chapter
under Coverage during a leave of absence or temporary
layoff, or
– You are not actively at work because you experience
medical complications during pregnancy or post‑partum
and you have exhausted the nine‑week short‑term
disability plan maternity benefit period, as described
later in this chapter under Maternity benefit.
• You must submit medical evidence provided by a qualified
doctor that you are disabled as defined by the Plan
(qualified doctors are legally licensed physicians and
practitioners who are not related to you and who are
performing services within the scope of their licenses,
including medical doctors [M.D.], osteopaths [D.O.], nurse
practitioners, physician’s assistants, psychologists, or other
medical practitioners whose services would be eligible for
reimbursement if submitted for reimbursement under the
Associates’ Health and Welfare Plan).
• You must receive approval by Sedgwick or Lincoln (as
applicable) of your claim.
If your disability is caused by a mental illness
or substance use disorder, you are encouraged
to seek treatment within 30 days from the
first date of absence from a psychologist,
psychiatrist, or clinical social worker who holds
a Master of Social Work (M.S.W.), specializes
in mental health and substance use disorders,
and is licensed pursuant to state law. See the
Resources for Living chapter for information
on resources that are available if you are
experiencing the effects of a mental illness or
substance use disorder.
These conditions apply whether you are covered under
the short‑term disability basic plan or enhanced plan or
New York short‑term disability enhanced plan or, except
as otherwise provided below, the short‑term disability
plan maternity benefit. Sedgwick or Lincoln may require
written proof of your disability or additional information
before making a decision on your claim. A statement by
your physician that you are unable to work does not by itself
qualify you for short‑term disability benefits. Approval of a
medical leave of absence does not constitute approval for
short‑term disability benefits.
As defined by the Plan, “disabled” or “disability” means
that you are unable to perform the essential duties of your
job for your normal work schedule, or a license required
for your job duties has been suspended due to a mental
or physical illness or injury, or pregnancy. Benefits are
payable during a loss of license only while you are disabled
and pursuing reinstatement of your license on a timely
basis. Timely pursuit of reinstatement means you apply
for reinstatement when your condition meets the criteria
and you provide information and forms requested by the
licensing agency on a timely basis until your license is
reinstated. The determination of whether you are disabled
is made by Sedgwick (or Lincoln, as applicable) on the basis
of objective medical evidence, which consists of facts and
findings, including but not limited to X‑rays, laboratory
reports, tests, consulting physician reports as well as
reports and chart notes from your physician. In addition,
you must be under the continuous care of a qualified
doctor and following the course of treatment prescribed.
Loss of license by itself is not sufficient for meeting the
definition of disability.
If Sedgwick or Lincoln requests that you be examined by an
independent physician or other medical professional, you
must attend the exam to be considered for benefits. The
company will cover the cost of any such examination.
If your disability is the result of more than one cause, you
will be paid as if they were one (as described later in this
chapter under If you return to work and become disabled
again). The maximum benefit for any one period of disability
is limited to 25 weeks, after the initial waiting period of
seven calendar days.
If your disability is due to pregnancy, you will be deemed to
meet the definition of disability, and Sedgwick (or Lincoln,
as applicable) will not require objective medical evidence
as a condition for approving your disability claim for the
short‑term disability plan maternity benefit, except in the
following situations:
• You begin your leave of absence more than two weeks
before your estimated delivery date, or
• You do not begin your leave of absence immediately after
your delivery date.
The maternity benefit generally begins on the earlier of two
weeks before your estimated delivery date or the actual
date of delivery.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
When benefits are not paid
Short‑term disability benefits will not be paid for an illness
or injury that:
• Arose before your coverage became effective
• Is not under the care of and being treated by a qualified
Note that associates in Washington, D.C. will generally not
receive benefits for periods prior to the date of application
for benefits, except in emergency situations.
STEP 2: Tell your doctor’s office that it will be contacted
and asked to complete an attending physician’s statement
and provide medical information, including:
doctor
• Is caused by taking part in an insurrection, rebellion or a
riot or civil disorder
• Resulted from your commission of or attempt to commit
a crime (e.g., assault, battery, felony, or any illegal
occupation or activity)
• Diagnosis
• Disability date and expected duration of disability
• Restrictions and limitations
• Physical and/or cognitive exam findings and test results
• Treatment plan, and
• Is one for which workers’ compensation benefits are paid,
• Doctor visit notes.
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or may be paid, if properly claimed, or
• Resulted from doing any work for pay or profit.
Filing a claim
If you experience a disabling illness or injury, or are
planning to begin maternity leave, follow these steps:
STEP 1: Notify Sedgwick to apply for a leave of absence
and file a short‑term disability claim as soon as you know
you will be absent from work due to an illness, injury
or pregnancy. Sedgwick will send you an initial packet
providing the information you will need and describing
any actions you will need to take. Notify your manager if
your illness or injury is related to your Walmart work, so
a workers’ compensation claim can be initiated. Report
your disability online by going to One.Walmart.com/LOA
> mySedgwick, or call 800-492-5678. Your claim cannot
be processed until you have stopped working.
Claims for short‑term disability benefits in Hawaii, New
Jersey, and New York must be submitted to Sedgwick within
30 days of the date your disability begins. Sedgwick will
notify Lincoln, which then manages your disability claim.
For all other states, you must submit your short‑term
disability claim to Sedgwick within 90 days of the date
your disability begins. Claims filed later than 90 days
after the date of disability may be denied unless Sedgwick
determines you had good cause for filing late.
Associates who work in Connecticut,
Massachusetts, Washington, D.C., and
Washington State are advised to promptly
apply to Sedgwick and to your state or locality
for state‑mandated state benefits. Refer to
the Resources chart at the beginning of the
chapter for contact information.
You must sign a form authorizing your doctor to release
this information. (This release will be included in the initial
packet that you receive from Sedgwick; however, if you are
filing your claim online, an electronic signature is accepted.)
STEP 3: Follow up with your doctor to ensure that
information was forwarded to the disability administrator.
Claims are determined under the time frames and
requirements set out in the Claims and appeals chapter. You
have the right to appeal a claim denial. See the Claims and
appeals chapter for details.
You may be required to provide written proof of your
disability or additional medical information before your
benefit payments begin.
If you become disabled, file your claim for benefits promptly.
A delay in filing could result in delayed benefit payment,
disruption in your wages, or the denial of your claim.
When benefits begin
If you are approved for short‑term disability benefits under
the short‑term disability plan, the benefit will begin, after
a waiting period of seven calendar days, on the eighth
calendar day after your disability begins. If your claim for
short‑term disability benefits is retroactively approved, any
benefit payments that would have otherwise been paid to
you while your claim decision was pending will be made to
you in a lump sum payment when approved.
You may use up to 40 hours of available paid time off (PTO)
during the benefit waiting period. PTO may not be used
while your claim decision is pending or you are receiving
short‑term disability benefits. PTO utilized beyond the
waiting period of seven calendar days must be repaid.
If you are receiving short‑term disability at the end of the
PTO plan year, please refer to your location’s PTO policy
for payout and/or carryover information. You do not accrue
additional PTO while receiving short‑term disability benefits.
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Calculating your benefit
The amount of your weekly short‑term disability benefit is
based on:
• Your average weekly wage
• The duration of your disability
• Whether you are eligible for the short‑term disability basic
plan, and
• Whether or not you are eligible and have enrolled in the
short‑term disability enhanced plan.
Your average weekly wage, for purposes of the full‑time
hourly short‑term disability benefit, including the maternity
benefit, is defined as follows:
AVERAGE WEEKLY WAGE
Length of
employment
Employed 12
months or more
Employed less
than 12 months
How average weekly wage is determined
Total gross pay ÷ 52 weeks
For example, the average weekly wage
for an associate with a total gross pay of
$36,400 is $700 ($36,400 ÷ 52)
Total gross pay ÷ number of weeks worked
For example, the average weekly wage
for an associate with a total gross pay
of $8,400 for 12 weeks of work is $700
($8,400 ÷ 12)
Total gross pay includes:
If a weekly benefit is payable for less than a week, your
pay will be 1/7 of the weekly benefit for each day you
were disabled.
There is no maximum weekly benefit under the short‑term
disability basic plan or enhanced plan, except in New York,
where the maximum is $6,000 per week. A hypothetical
benefit calculation is shown below, using an average weekly
wage of $700.
YOUR SHORT‑TERM DISABILITY BENEFIT: AN EXAMPLE
If you have
Your benefit is
Short‑term disability
basic plan coverage
Short‑term disability
enhanced plan
coverage
50% of your average weekly wage
Average weekly wage: $700
50% of $700: $350
60% of your average weekly wage
Average weekly wage: $700
60% of $700: $420
If a weekly benefit is payable for less
than a week, your pay will be 1/7 of
the weekly benefit for each day you
were disabled.
NOTE: For associates who are eligible for legally mandated
benefits as well as benefits under Walmart’s short‑term
disability basic or enhanced plans, the amount of the benefit
under Walmart’s short‑term disability plans will be reduced
by the amount of the legally mandated benefit. See Legally
mandated plans earlier in this chapter.
• Overtime
• Certain bonuses, as determined by the Plan Administrator
MATERNITY BENEFIT
on a consistent basis
• PTO and other illness protection benefits (not including
any previously paid disability benefits), and
• Regular earnings for the 26 pay periods prior to your last
day worked (or for the number of pay periods worked if
less than 26).
If you have any pay periods in which you had no earnings,
those pay periods are excluded and the number of pay
periods used for the calculation will be decreased.
NOTE: For most Walmart associates, 12 months is the
equivalent of 26 pay periods. Rhode Island associates, who
are paid weekly, are an exception.
For full‑time hourly associates, except for those who work
in California, Hawaii, New Jersey, and Rhode Island, if your
disability is due to pregnancy, and you begin your short‑term
disability leave on your delivery date or up to two weeks
before your expected delivery date, you will be deemed
to meet the plan’s definition of disability and eligible for
maternity disability benefits. The short‑term disability plan
for hourly associates pays a maternity benefit of 100% of your
average weekly wage for up to the first nine weeks, after
an initial waiting period of seven calendar days. However,
if you begin your leave later than your actual delivery date,
you must meet the plan’s definition of disability and will be
eligible for the non‑maternity disability benefits only.
If you are eligible for benefits and continue to meet the
definition of disability after the first nine weeks of disability
payments, the short‑term disability basic plan will pay up to
50% of your average weekly wage and the enhanced plan
will pay up to 60% of your average weekly wage, from week
10 up to 25 weeks of benefit payments.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Full‑time hourly associates who work in California, Hawaii,
New Jersey, and Rhode Island are not eligible for the
Walmart short‑term disability basic or enhanced plans
because these states have legally mandated disability plans
with their own eligibility terms. However, if you work in
one of these states and your disability is due to pregnancy,
you may be eligible for maternity benefits under the
short‑term disability plan for hourly associates, subject to
the following:
• If you are eligible for legally mandated short‑term
disability benefits as a result of your pregnancy,
the short‑term disability plan maternity benefits
supplements the legally mandated short‑term disability
benefits, as shown in the chart below.
• If you are not eligible for legally mandated short‑term
disability benefits as a result of your pregnancy, the
short‑term disability plan maternity benefit is equal to
100% of your average weekly wage up to the first nine
weeks, after an initial waiting period of seven calendar
days. The short‑term disability maternity benefits will end
after nine weeks.
If you begin your leave later than your actual delivery date,
you will not be eligible for maternity benefits under the
short‑term disability plan for hourly associates.
If you are an associate who works in Hawaii, New Jersey,
or New York, your short‑term disability plan maternity
benefits are administered by Lincoln and Sedgwick. If you
work in any of these states, you should file a claim for
maternity benefits with Sedgwick, who will notify Lincoln
(see Filing a claim, Step 1, earlier in this chapter). Sedgwick
administers short‑term disability plan maternity benefits
for associates who work in all other states and localities.
Maternity benefits under the short‑term disability plan for
full‑time hourly associates are as described here:
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MATERNITY BENEFIT
Associate’s work location (state or locality)
Up to 9 weeks*
Beyond 9 weeks*
If you work in a state or locality with no legally
mandated plan
100% of your average weekly
wage after an initial waiting period
of 7 calendar days.
If (i) you work in a state or locality with a legally
mandated plan, (ii) you are eligible to receive
the state benefit due to your pregnancy, and
(iii) you work in a location eligible for the
Walmart short-term basic or plan
100% of your average weekly wage,
reduced by any legally mandated
benefits that are payable at
the applicable state or local
government rate, after an initial
waiting period of 7 calendar days.
If (i) you work in a state or locality with a legally
mandated plan, (ii) you are eligible to receive
the state benefit due to your pregnancy, and
(iii) you do not work in a location eligible for
the Walmart short-term disability basic or
enhanced plan
100% of your average weekly wage,
reduced by any legally mandated
benefits that are payable at
the applicable state or local
government rate, after an initial
waiting period of 7 calendar days.
100% of your average weekly
wage after an initial waiting period
of 7 calendar days.
If you experience medical complications
during pregnancy or post‑partum, benefits
may be payable under the short‑term
disability basic or enhanced plans for
hourly associates, as described above.
Additional benefits may be available through
your state or local government and benefits
may be payable under the short‑term
disability basic or enhanced plans for
hourly associates as described above.
Additional benefits may be available
through your state or local government.
The Walmart short‑term disability basic and
enhanced plans are not available; maternity
benefits end after the first 9 weeks of
benefit payments.
If you experience medical complications
during pregnancy or post‑partum, benefits
may be payable under the short‑term
disability basic or enhanced plans for
hourly associates, as described above.
100% of your average weekly
wage after an initial waiting period
of 7 calendar days.
The Walmart short‑term disability basic and
enhanced plans are not available; maternity
benefits end after the first 9 weeks of
benefit payments.
If (i) you work in a state or locality with a legally
mandated plan, (ii) you are not eligible to
receive the state or local government benefit
due to your pregnancy, and (iii) you work in a
location eligible for the Walmart short-term
disability basic or enhanced plan
If (i) you work in a state or locality with a legally
mandated plan, (ii) you are not eligible to
receive the state or local government benefit
due to your pregnancy, and (iii) you do not work
in a location eligible for the Walmart short-term
disability basic or enhanced plan
* You may be eligible for parental pay equal to 100% of your average weekly wage under Walmart’s Parental Pay Policy. You cannot
receive parental pay while receiving short‑term disability plan maternity benefits. For more information, refer to the Parental Pay
Policy on One.Walmart.com.
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TAXES AND YOUR SHORT-TERM
DISABILITY BENEFIT
The taxation of benefits payable to you depends on whether
you are enrolled only in the short‑term disability basic
benefit or in the enhanced benefit. If you are enrolled
in short‑term disability basic, benefits payable to you
are subject to taxes. This is because you do not make
contributions to the short‑term disability basic plan and you
do not pay any tax on the coverage that Walmart provides.
If you are enrolled in short‑term disability enhanced, only
a portion of your benefits will be taxed, because both
Walmart and you pay for the cost of the coverage through
a combination of Walmart pretax and associate after‑tax
contributions. Walmart generally withholds federal, state,
local and Social Security taxes from the portion of the
benefit that is taxable.
If you work in New York, please contact Lincoln for
information regarding the taxation of your short‑term
disability plan basic or enhanced benefits. Associates in
other states or localities with legally mandated benefits
who are not eligible to participate in the short‑term disability
basic or enhanced plans should either contact Lincoln (if
you work in Hawaii or New Jersey) or the state or locality
for information about the tax status of state benefits.
The Plan Administrator cannot guarantee the specific tax
consequences that will result from your receipt of benefits
under Walmart’s short‑term disability plan. The Plan
Administrator is not providing legal advice. If you need an
answer upon which you can rely, you may wish to consult a
tax advisor.
The Plan has the right to recover from you, and you must
repay, any amount overpaid to you for short‑term disability
benefits under this Plan. See The Plan’s right to recover
overpayment and The Plan’s right to salary/wage deduction
in the Claims and appeals chapter. If you do not repay
overpaid amounts in a timely manner, the company will first
deduct such amounts from future disability payments (if
any), then may treat the portion of such amounts that were
not taxed when paid as taxable wages to you (reportable on
your Form W‑2) or, alternatively, deduct such amounts from
your paycheck, to the extent permitted by law.
When short-term disability benefit
payments end
If you are receiving short‑term disability benefit payments
from the Plan due to an approved disability, your benefit
payments from the Plan will end on the earliest of:
• The date you no longer meet the plan’s definition of disabled
• The date you fail to furnish the required proof of disability
when requested to do so by Sedgwick or Lincoln
• The date you are no longer under the continuous care and
treatment of a qualified doctor
• The date you refuse to be examined, if Sedgwick or Lincoln
requires an examination
• The last day of the maximum period for which benefits
are payable (25 weeks or nine weeks for maternity
disability benefits)
• The date you are medically able and qualified to work in a
similar full‑time position offered to you by Walmart, or
• The date of your death.
When your short‑term disability benefits end, and for any
reason you do not return to work, you must request an
extension of your leave (refer to the Resources chart at the
beginning of the chapter for contact information). Failure to
do so may result in your employment being terminated.
State and local government short‑term disability programs
may have different end dates from Walmart’s coverage.
Returning to work
Sedgwick will contact you before your expected return‑
to‑work date and advise you of steps you may need to
take, including getting a return‑to‑work certification
completed by your doctor. In some cases, your doctor
may release you to work with certain medical restrictions;
any such restrictions should be explicitly stated on your
return‑to‑work certification or written release. If you
receive a return‑to‑work certification containing medical
restrictions, you may be subject to a review to determine
whether a job adjustment or accommodation will help you
return to work.
Notify Sedgwick when you physically return to work. If your
short‑term disability benefits have ended and you have
not returned to work or communicated your intentions,
Sedgwick will notify you of your options, which include
requesting an extension of your leave or voluntarily
terminating employment. Failure to request an extension
may result in your employment being terminated.
If you return to work within 30 days of the end of your
approved disability period, you will be reinstated to the
disability coverage you had prior to your disability. If you
do not return to work within 30 days of the end of your
approved disability period, your coverage will lapse unless
you return to work and meet the active work requirement
within one year. You will not be required to satisfy the
12‑month waiting period again.
If you return to work and become disabled again
If you return to work for 30 calendar days or less of active
full‑time work (with or without medical restrictions) and
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In addition, coverage under the short‑term disability
enhanced plan would end when you voluntarily drop your
coverage, as follows:
• After a status change event: coverage ends on the
effective date of the event. See Status change events in
the Eligibility and enrollment chapter for information.
• At Annual Enrollment: coverage ends on December 31 of
the current year.
If you leave the company and
are rehired
If you leave the company and return to full‑time work for
the company within 13 weeks from your last day worked, you
will automatically be reenrolled for the same coverage plan
you had prior to leaving the company (or the most similar
coverage offered under the Plan). If you are automatically
reenrolled in short‑term disability enhanced plan coverage
and choose to drop it after you return, you may do so within
60 days of resuming employment.
If you return to full‑time work after 13 weeks, you will be
considered newly eligible and may enroll for coverage under
the time periods and conditions described in the Eligibility
and enrollment chapter.
If you lose and then regain eligibility
or drop coverage and reenroll
If you lose eligibility and then regain eligibility or drop
enhanced plan coverage and reenroll within 30 days, you will
automatically be reenrolled for the same coverage you had
prior to losing eligibility or dropping coverage (or the most
similar coverage offered under the Plan).
If you lose eligibility and then regain eligibility or drop
enhanced plan coverage and reenroll after 30 days, you will
be considered newly eligible and may enroll for coverage
under the time periods and conditions described in the
Eligibility and enrollment chapter.
become disabled again from the same or a related condition
that caused the first period of disability, as determined by
Sedgwick or Lincoln, known as a “relapse/recurrent claim,”
your short‑term disability benefits will pick up where
they left off before you came back to work. There will be
no additional waiting period of seven calendar days. The
combined benefit duration for both periods of disability will
not exceed 25 weeks.
If you have returned to active full‑time work for more than
30 calendar days and then become disabled from the same
or a related cause, it will be considered a new disability,
and you may be able to receive up to 25 weeks of benefits.
A new benefit waiting period of seven calendar days
will apply.
If you return to active full‑time work for any number of
calendar days and then become disabled from a new and
unrelated cause, it will be considered a new disability, and
you may qualify for up to 25 weeks of benefits. A new
benefit waiting period of seven calendar days will apply.
Coverage during a leave of absence
or temporary layoff
Once your short‑term disability coverage is effective and
you are eligible to file a claim for benefits, if you are not
actively at work due to an approved non‑disability leave of
absence or temporary layoff, you will continue to be eligible
for short‑term disability benefits for 90 days from your
last day of work. Your eligibility for short‑term disability
benefits ends on the 91st day after the beginning of your
approved non‑disability leave or temporary layoff, but is
reinstated if you return to active work status within one year.
If you return to active work within one year, you will not be
required to satisfy the 12‑month waiting period again.
When coverage ends
Your short‑term disability basic plan and enhanced plan
coverage, as well as your eligibility for the short‑term
disability plan maternity benefit, ends:
• At termination of your employment or on the date you
otherwise lose eligibility
• On the last day of the pay period when your job status
changes from an eligible job status
• On the date of your death
• On the 91st day of an approved non‑disability leave of
absence (unless you return to work)
• On the 31st day following the end of your approved
disability period (unless you return to work), or
• When the benefit is no longer offered by the company.
Salaried short-term
disability plan
Salaried short‑term disability
How salaried short‑term disability is administered
When you qualify for benefits
When benefits are not paid
Filing a claim
Your pay after filing a claim
Benefits determination
When benefits begin
Calculating your benefit
When short‑term disability benefit payments end
Returning to work
Coverage during a leave of absence or temporary layoff
When coverage ends
If you leave the company and are rehired
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This information does not create an express or implied contract of employment or any other contractual
commitment. Walmart may modify this information at its sole discretion without notice, at any time,
consistent with applicable law.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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Salaried short-term disability plan
If pregnancy, a scheduled surgery, or an unexpected illness or injury keeps you off the job for an
extended period, this plan for salaried associates can protect part of your paycheck. When you can’t
work, the Walmart salaried short‑term disability plan works for you.
RESOURCES
Find What You Need
Online
Other Resources
To file a claim or get more information Go to One.Walmart.com/LOA
Call Sedgwick/Lincoln at 800-492-5678
To file a state benefit claim if you work
in any of the following areas:
> mySedgwick
California (eCommerce associates)
Go to edd.ca.gov
Call 800-480-3287
Connecticut
Massachusetts
Washington, D.C.
Washington State
Go to ctpaidleave.org
Go to paidleave.mass.gov
Call 833-344-7365
Go to dcpaidfamilyleave.dc.gov
Call 202-899-3700
Go to paidleave.wa.gov
Call 833-717-2273
Request an appeal of a denied
short‑term disability claim
Go to One.Walmart.com/LOA
> mySedgwick
Call Sedgwick at 800-492-5678
What you need to know about salaried short-term disability
• If you are a salaried (management) associate, you are automatically enrolled in the salaried short‑term disability
plan. Coverage is effective as of your date of hire and there is no cost to you.
• If you become disabled and are eligible to receive short‑term disability benefits, the salaried short‑term disability
plan replaces 100% of your base pay for up to six weeks and 75% of your base pay for up to 19 additional weeks,
after an initial waiting period of seven calendar days. (Different rules may apply to work‑related disabilities that
qualify for workers’ compensation through Walmart. See the chart titled Your salaried short-term disability plan
benefit for more information.)
• If your disability is due to pregnancy, the short‑term disability plan replaces 100% of your average weekly wage
for nine weeks, after an initial waiting period of seven calendar days. Generally no medical evidence is required
for the first nine weeks of maternity benefit payments. Additional benefits may be payable after the first nine
weeks of benefits if you experience medical complications during pregnancy or post‑partum. For details, see
Maternity benefit later in this chapter.
• The salaried short‑term disability plan is not a benefit covered by ERISA and is not part of the Associates’ Health
and Welfare Plan.
• The claims and appeals procedures described in this chapter apply to the salaried short‑term disability benefit
rather than the procedures in the Claims and appeals chapter.
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Salaried short-term disability
You are automatically enrolled for coverage in the salaried
short‑term disability plan as of your date of hire if you are
a salaried/management associate (exempt). For details
about eligible job classifications, see the Enrollment
and effective dates by job classification section in the
Eligibility and enrollment chapter.
How salaried short-term disability
is administered
Salaried short‑term disability coverage is administered by
Sedgwick Claims Management Services, Inc. (Sedgwick) and
is provided by the company at no cost to you.
If you become disabled and eligible to receive short‑term
disability benefits, the salaried short‑term disability plan
generally pays 100% of your base pay for up to six weeks
of an approved disability, after an initial waiting period of
seven calendar days of continuous disability. (Disabilities
that qualify for workers’ compensation through Walmart
are treated differently, as described in the chart titled
Your salaried short-term disability plan benefit.) If you
remain disabled and eligible for benefits after the first
six weeks of disability payments, the salaried short‑term
disability plan will pay 75% of your base pay for up to
19 additional weeks.
If your disability is due to pregnancy, the salaried short‑term
disability plan pays a maternity benefit of 100% of your base
pay for the first nine weeks, after an initial waiting period
of seven calendar days. If you remain disabled and eligible
for benefits after the first nine weeks of disability pay, the
salaried short‑term disability plan will pay 75% of your base
pay for up to 16 additional weeks of benefit payments.
For your pay to continue during the initial waiting period
of seven calendar days, you may use paid time off (PTO).
Salaried short‑term disability benefits begin on the eighth
calendar day after your eligible disability begins. PTO may
not be used while your claim decision is pending or while
receiving short‑term disability benefits.
If you are receiving short‑term disability at the end of the
PTO plan year, please refer to your location’s PTO policy for
payout and/or carryover information.
LEGALLY MANDATED PLANS
Short‑term disability benefits provided by individual states
and local governments generally have no impact on your
eligibility for the salaried short‑term disability benefit
through Walmart.
Exceptions to this policy apply to all eCommerce salaried
associates who work in California and all associates who
work in Connecticut, Massachusetts, Washington, D.C., and
Washington State. General information can be found in the
following chart.
LEGALLY MANDATED PLANS
eCommerce salaried associates who work
in California and salaried associates who
work in Connecticut, Massachusetts,
Washington, D.C., and Washington State
Associates are eligible to participate in the salaried short‑term disability plan to
supplement their state benefits.
The amount of the benefit under the salaried short term disability plan will be
reduced by the amount of the legally mandated benefit Sedgwick estimates that you
are eligible to receive from the state or locality, regardless of whether you apply for
that legally mandated benefit. The total benefits payable under the salaried short‑
term disability plan to supplement your state or locality benefit will not exceed
the level of benefits otherwise payable under the plan. Upon request, you will be
responsible for providing your award letter from the state or locality to Sedgwick.
If Sedgwick overestimated what your mandated benefit would be, meaning that you
were paid less under the salaried short‑term disability plan than you were entitled to,
you will be paid the difference in a lump sum payment. If Sedgwick underestimated
what your mandated benefit would be, meaning that you were paid more under the
salaried short‑term disability plan than you were entitled to, you must repay any
amount overpaid to you. See The Plan’s right to recover overpayment and The Plan’s
right to salary/wage deduction in the Claims and appeals chapter. If you do not repay
overpaid amounts in a timely manner, the company may deduct such amounts from
your paycheck or future disability benefit payments, to the extent permitted by law.
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When you qualify for benefits
To qualify for short‑term disability benefits through the
salaried short‑term disability plan, you must meet the
following requirements:
• Your disability must have occurred on or after the
effective date of your coverage.
• You must be actively at work (as defined below) at the time
of your disability unless:
– You are not actively at work in certain cases of
leave of absence or layoff, as described later in this
chapter under Coverage during a leave of absence or
temporary layoff; or
– You are not actively at work because you experience
medical complications during pregnancy or post‑partum
and you have exhausted the nine‑week maternity
benefit period, as described later in this chapter under
Maternity benefit.
• You must submit medical evidence provided by a
qualified doctor that you are disabled as defined by the
salaried short‑term disability plan (qualified doctors are
legally licensed physicians and practitioners who are not
related to you and who are performing services within
the scope of their licenses, including medical doctors
[M.D.], osteopaths [D.O.], nurse practitioners, physician’s
assistants, psychologists, or other medical practitioners
whose services would be eligible for reimbursement
if submitted for reimbursement under the Associates’
Health and Welfare Plan).
• You must receive approval by Sedgwick of your claim.
Being actively at work means that you have earned wages
in the pay period immediately preceding your disability.
Sedgwick may require written proof of your disability or
additional information before making a decision on your
claim. A statement by your physician that you are unable to
work does not by itself qualify you for short‑term disability
benefits. Approval of a medical leave of absence does not
constitute approval for short‑term disability benefits.
If your disability is caused by a mental illness
or substance use disorder, you are encouraged
to seek treatment within 30 days from the
first date of absence from a psychologist,
psychiatrist, or clinical social worker who
holds a Master of Social Work (M.S.W.),
specializes in mental health and substance
use disorders, and is licensed pursuant to state
law. See the Resources for Living chapter for
information on resources that are available if
you are experiencing the effects of a mental
illness or substance use disorder.
As defined by the salaried short‑term disability plan,
“disabled” or “disability” means that you are unable to
perform the essential duties of your job for your normal work
schedule, or a license required for your job duties has been
suspended due to a mental or physical illness or injury, or
pregnancy. Benefits are payable during a loss of license only
while you are disabled and pursuing reinstatement of your
license on a timely basis. Timely pursuit of reinstatement
means you apply for reinstatement when your condition
meets the criteria and you provide information and forms
requested by the licensing agency on a timely basis until
your license is reinstated. The determination of whether you
are disabled is made by Sedgwick on the basis of objective
medical evidence, which consists of facts and findings,
including but not limited to X‑rays, laboratory reports, tests,
consulting physician reports as well as reports and chart
notes from your physician. In addition, you must be under
the continuous care of a qualified doctor and following the
course of treatment prescribed. Loss of license by itself is not
sufficient for meeting the definition of disability.
If Sedgwick requests that you be examined by an
independent physician or other medical professional, you
must attend the exam to be considered for benefits. The
company will cover the cost of any such examination.
If your disability is the result of more than one cause, you
will be paid as if they were one (as described later in this
chapter under If you return to work and become disabled
again). The maximum benefit for any one period of disability
is limited to 25 weeks, after the initial waiting period of
seven calendar days.
If your disability is due to pregnancy, you will be deemed
to meet the definition of disability, and Sedgwick will not
require objective medical evidence as a condition for
approving your disability claim for the short‑term disability
maternity benefit, except in the following situations:
• You begin your leave of absence more than two weeks
before your estimated delivery date, or
• You do not begin your leave of absence immediately after
your delivery date.
The maternity benefit generally begins on the earlier of two
weeks before your estimated delivery date or the actual
date of delivery.
When benefits are not paid
Short‑term disability benefits will not be paid for an illness
or injury that:
• Arose before your coverage became effective
• Is not under the care of and being treated by a qualified
doctor
• Is caused by taking part in an insurrection, rebellion or a
riot, or civil disorder
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• Resulted from your commission of or attempt to commit
a crime (e.g., assault, battery, felony, or any illegal
occupation or activity), or
• Resulted from doing any work for pay or profit.
You may be required to provide written proof of your
disability or additional medical information before your
benefit payments begin.
Filing a claim
If you experience a disabling illness or injury, or are planning
to begin maternity leave, follow these steps:
STEP 1: Notify Sedgwick to apply for a leave of absence and
file a short‑term disability claim as soon as you know you will
be absent from work due to an illness, injury or pregnancy.
Sedgwick will send you an initial packet providing the
information you will need and describing any actions you will
need to take. Notify your manager if your illness or injury is
related to your Walmart work, so a workers’ compensation
claim can be initiated. Report your disability online by going to
One.Walmart.com/LOA > mySedgwick, or call 800-492-5678.
Processing of your claim cannot begin until you have stopped
working. All claims for benefits under Walmart’s salaried
short‑term disability plan must be submitted to Sedgwick
within 90 days of the date your disability begins. Claims filed
later than 90 days after the date of disability may be denied
unless Sedgwick determines you had good cause for filing late.
Associates who work in Connecticut, Massachusetts,
Washington, D.C., and Washington State are advised to
promptly apply to Sedgwick and to your state or locality for
state‑mandated state benefits. Refer to the Resources chart
at the beginning of the chapter for contact information.
Note that associates in Washington, D.C. will generally not
receive benefits for periods prior to the date of application
for benefits, except in emergency situations.
STEP 2: Tell your doctor’s office that it will be contacted
and asked to complete an attending physician’s statement
and provide medical information, including:
• Diagnosis
• Disability date and expected duration of disability
• Restrictions and limitations
• Physical and/or cognitive exam findings and test results
• Treatment plan, and
• Doctor visit notes.
You must sign a form authorizing your doctor to release this
information. This release will be included in the initial packet
that you receive from Sedgwick; however, if you are filing
your claim online, an electronic signature is accepted.
STEP 3: Follow up with your doctor to ensure that
information was forwarded to the disability administrator.
If you become disabled, file your claim for
benefits promptly. A delay in filing could
result in delayed benefit payment, disruption
in your wages, or the denial of your claim.
Your pay after filing a claim
Sedgwick will send you an initial packet when you file your
claim. You will have until the Medical Due Date, which is
stated in your initial packet, to provide the required medical
documentation. In order for your pay to continue during
the initial waiting period of seven calendar days, you may
use paid time off (PTO). Following your initial waiting period
of seven calendar days, your pay will continue until your
Medical Due Date; this pay is known as “provisional pay.”
Your pay will be suspended after your Medical Due Date if
the required medical documentation has not been approved.
Be sure to provide the required medical documentation at
your earliest opportunity. If you do not meet the Medical
Due Date deadline, your pay will be suspended effective the
first day of the pay period in which it falls. If your claim is
approved, the approval will be effective as of the date of your
disability, and the provisional pay you received while your
claim was pending will count toward your disability benefit.
If your claim is denied before the Medical Due Date due
to your medical circumstances not meeting the salaried
short‑term disability plan’s definition of disability, your
provisional pay will be stopped and Walmart will commence
efforts to recover the amount paid to you for the period
following your illness or injury.
You will not receive provisional pay during any period when
a determination is being made regarding a relapse/recurrent
claim (see If you return to work and become disabled again
later in this chapter).
Benefits determination
Sedgwick makes a decision within 45 days of receiving
your properly filed claim. The time for a decision may be
extended for up to two additional 30‑day periods. You will
be notified in writing before any extension period that an
extension is necessary due to matters beyond Sedgwick’s
control. Those matters must be identified and you must
be given the date by which Sedgwick will make a decision.
If your claim is extended due to your failure to submit
information Sedgwick deems necessary to decide your
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claim, the time for decision will be suspended as of the date
on which the notification of the extension is sent to you
until the date Sedgwick receives your response. If Sedgwick
approves your claim, the decision will contain information
sufficient to inform you of that decision.
If Sedgwick denies your claim, you will be sent a written
notification of the denial, which will include:
• Specific reasons for the decision
If your appeal is denied in whole or in part, you will receive
a written notification of the denial that will include:
• The specific reason(s) for the adverse determination
• Reference to the specific plan provisions on which the
determination was based
• A statement describing your right to request copies, free
of charge, of all documents, records, or other information
relevant to your claim
• Specific reference to the policy provisions on which the
• A statement that you have the right to obtain, upon
decision is based
• A description of any additional material or information
necessary for you to perfect the claim and an explanation
of why such material or information is necessary
• A description of the appeal procedures and time limits
applicable to such procedures, and
• If an internal rule, guideline, protocol, or other similar
criteria was relied upon in making the denial, either:
– The specific rule, guideline, protocol, or other similar
criteria, or
– A statement that such a rule, guideline, protocol, or
other similar criteria was relied upon in making the
denial and that a copy will be provided free of charge
to you upon request.
APPEALING A DISABILITY CLAIM THAT HAS
BEEN FULLY OR PARTIALLY DENIED
If your claim for benefits is denied and you would like
to appeal, you must submit a written or oral appeal to
Sedgwick within 180 days of the denial. Your appeal should
include any comments, documents, records, or any other
information you would like considered.
For associates in states or localities with legally
mandated plans, such as Connecticut, Massachusetts,
Washington, D.C., and Washington State, you should
submit your appeal directly to the state or local
government. If you are appealing your Sedgwick claim,
file your appeal with Sedgwick as noted below.
You have the right to request copies, free of charge, of all
documents, records, or other information relevant to your
claim. Your appeal will be reviewed, without regard to your
initial determination, by someone other than the party
who decided your initial claim.
Sedgwick will make a determination on your appeal within
45 days of the receipt of your appeal request. This period
may be extended by up to an additional 45 days if it is
determined that special circumstances require an extension
of time. You will be notified prior to the end of the 45‑day
period if an extension is required. If you are asked to provide
additional information, you will have 45 days from the date
you are notified to provide the information, and the time to
make a determination will be suspended until you provide
the requested information (or the deadline to provide the
information, if earlier).
request and free of charge, a copy of internal rules or
guidelines relied upon in making this determination, and
• A statement describing any appeal procedures offered
by the Plan.
VOLUNTARY SECOND APPEAL OF A SALARIED
SHORT-TERM DISABILITY CLAIM
If your appeal is denied, you may make a voluntary second
appeal of your denial orally or in writing to Sedgwick. You
must submit your second appeal within 180 days of the
receipt of the written notice of denial. You may submit
any written comments, documents, records, and any
other information relating to your claim. The same criteria
and response times that applied to your first appeal, as
described earlier, are generally applied to this voluntary
second appeal.
All salaried short‑term disability appeals (initial appeals and
voluntary second appeals) should be sent to:
Walmart Disability and Leave Service Center at Sedgwick
National Appeals Unit
P.O. Box 14748
Lexington, Kentucky 40512-4748
When benefits begin
If you are approved for short‑term disability benefits,
the benefit will begin after a waiting period of seven
calendar days, on the eighth calendar day after your
disability begins. (There is no waiting period for
work‑related disabilities that qualify for workers’
compensation through Walmart.)
In order for your pay to continue during the initial waiting
period of seven calendar days, you may use paid time off
(PTO). Salaried short‑term disability benefits begin on the
eighth calendar day after your eligible disability begins.
PTO may not be used while your claim decision is pending
or while receiving short‑term disability benefits (but see
Your pay after filing a claim earlier in this chapter for
information regarding provisional pay that may apply after
your initial waiting period of seven calendar days).
If you are receiving short‑term disability at the end of the
PTO plan year, please refer to your location’s PTO policy
for payout and/or carryover information.
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Calculating your benefit
The amount of your short‑term disability benefit is based on:
• Your base pay as of your last day worked, and
• The duration of your disability.
Base pay, for purposes of the salaried short‑term disability benefit, is defined as follows:
ASSOCIATE TYPE
BASE PAY
Exempt associates
Gross biweekly salary
Non‑exempt associates
Hourly rate multiplied by normal hours scheduled per pay period
If you become disabled and eligible to receive short‑term disability benefits, the salaried short‑term disability plan pays
benefits as described below:
YOUR SALARIED SHORT‑TERM DISABILITY PLAN BENEFIT
Your benefit is:
Duration of your disability
Up to 7 weeks
More than 7 weeks, up to
26 weeks
If your disability does not qualify for
workers’ compensation through Walmart
If you have a work-related disability that qualifies
for workers’ compensation through Walmart
After an initial waiting period of 7
calendar days, 100% of your base pay.
Benefits begin on the 8th calendar day.
You may use PTO during your first 7
calendar days of continuous disability.
75% of your base pay.
For example, if your base pay is $1,000,
75% of $1,000 is a $750 benefit.
100% of your base pay, with no initial waiting period.
Workers’ compensation benefits are payable at the
applicable state rate; short‑term disability benefits
make up the difference up to 75% of your base pay.
For example, if your base pay is $1,000 and workers’
compensation pays 66% for your disability, or $660,
short‑term disability will pay an additional $90, for a
total benefit of $750.
(If the legally mandated workers’ compensation rate
exceeds 75% of your base pay, you will not receive
any short‑term disability benefit.)
If you are able to return to work after a period of short‑term disability and need to miss work periodically for reasons related to
your disability, notify Sedgwick and your facility of your situation. Your treatment may be covered under your prior short‑term
disability claim for up to 12 months from the date you return to work from your short‑term disability claim. Salaried short‑term
disability generally pays 100% of your base pay for the duration of your approved intermittent leave. You will not need to use PTO
for the absences.
NOTE: For associates who are eligible for legally mandated benefits (as noted in Legally mandated plans earlier in this chapter)
as well as benefits under Walmart’s salaried short‑term disability plan, the amount of the benefit under Walmart’s salaried
short‑term disability plan will be reduced by the amount of the state‑sponsored benefit.
If a benefit is payable for less than a week, your pay will be based on your base pay divided by your regular work schedule for
each day you are disabled.
WORKERS’ COMPENSATION AND YOUR SHORT-TERM DISABILITY BENEFITS
Workers’ compensation and short‑term disability benefits are made as separate payments, except in the states of Texas
and Wyoming, where the entire benefit is included in the payment you receive from Walmart.
If you are receiving workers’ compensation benefits for an unrelated injury or illness, any short‑term disability benefit
for which you are eligible will be reduced, or offset, by any workers’ compensation benefits you are eligible to receive.
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MATERNITY BENEFIT
Maternity benefits under the salaried short‑term disability plan are as described here:
MATERNITY BENEFIT
Duration of benefit
Your benefit is:
Up to 9 weeks*
100% of your base pay after
an initial waiting period of 7
calendar days.
If you are eligible for legally mandated benefits in California (for
eCommerce salaried associates); Connecticut; Massachusetts;
Washington, D.C.; and Washington State:
Legally mandated benefits are payable at the applicable state or local
government rate; the Walmart salaried short‑term disability maternity
benefit will make up the difference between the state or local
government benefit and 100% of your base pay after an initial waiting
period of 7 calendar days.
Maternity benefits under the salaried short‑term disability plan begin on the 8th calendar day after your
eligible disability begins. You may use PTO during your first 7 calendar days of continuous disability.
* You may also be eligible for parental pay and family care pay equal to 100% of your base pay. You cannot receive parental pay and family
care pay benefits while receiving short‑term disability plan maternity benefits. For more information, refer to the Parental Pay Policy
and Family Care Pay Policy on One.Walmart.com.
NOTE: For associates who are eligible for legally mandated benefits (as noted in Legally mandated plans earlier in this chapter) as
well as benefits under the salaried short‑term disability plan, the amount of the benefit under the salaried short‑term disability
plan will be reduced by the amount of the legally mandated benefit.
If you begin your short‑term disability leave on your delivery
date or up to two weeks before your expected delivery date,
you will be deemed to meet the plan’s definition of disability
and eligible for maternity disability benefits.
If you begin your leave later than your actual delivery date,
you must meet the plan’s definition of disability and will be
eligible for the non‑maternity disability benefits only.
If you experience medical complications during pregnancy
or post‑partum, benefits may be payable under the salaried
short‑term disability plan after the end of the nine‑week
duration of maternity benefits if you continue to meet
the definition of disability. Benefits would be equal to
75% of your base pay from week 10, up to 25 weeks of
benefit payments.
TAXES AND YOUR SHORT-TERM
DISABILITY BENEFIT
Benefits payable to you under the salaried short‑term
disability plan are company‑provided, at no cost to you.
Because you do not make any contributions to the salaried
short‑term disability plan and you do not pay any tax on
the coverage that Walmart provides, any benefits payable
to you are subject to taxes. Walmart generally withholds
federal, state, local, and Social Security taxes from the
amount of your benefit payments.
Walmart cannot guarantee the specific tax consequences
that will result from your receipt of benefits under
Walmart’s short‑term disability plan. Walmart is not
providing legal advice. If you need an answer upon which
you can rely, you may wish to consult a tax advisor.
The salaried short‑term disability plan has the right
to recover from you, and you must repay, any amount
overpaid to you for short‑term disability benefits under
this plan. See The Plan’s right to recover overpayment and
The Plan’s right to salary/wage deduction in the Claims and
appeals chapter. If you do not repay overpaid amounts in
a timely manner, the company may deduct such amounts
from your paycheck or future disability benefit payments,
to the extent permitted by law.
When short-term disability benefit
payments end
If you are receiving short‑term disability benefit payments
from the salaried short‑term disability plan due to an
approved disability, your benefit payments from the plan
will end on the earliest of:
• The date you no longer meet the plan’s definition of disabled
• The date you fail to furnish the required proof of disability
when requested to do so by Sedgwick
• The date you are no longer under the continuous care and
treatment of a qualified doctor
• The date you refuse to be examined, if Sedgwick requires
an examination
• The last day of the maximum period for which benefits
are payable (25 weeks, or nine weeks for maternity
disability benefits)
• The date you are medically able and qualified to work in a
similar full‑time position offered to you by Walmart
• The date your employment terminates, or
• The date of your death.
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When your short‑term disability benefits end and for any
reason you do not return to work, you must request an
extension of your leave (refer to the Resources chart at the
beginning of the chapter for contact information). Failure to
do so may result in your employment being terminated.
If you return to active full‑time work for any number of
calendar days and then become disabled from a new and
unrelated cause, it will be considered a new disability, and
you may qualify for up to 25 weeks of benefits. A new
benefit waiting period of seven calendar days will apply.
Returning to work
Sedgwick will contact you before your expected
return‑to‑work date and advise you of steps you may need
to take, including getting a return‑to‑work certification
completed by your doctor. In some cases, your doctor
may release you to work with certain medical restrictions;
any such restrictions should be explicitly stated on your
return‑to‑work certification or written release. If you
receive a return‑to‑work certification containing medical
restrictions, you may be subject to a review to determine
whether a job adjustment or accommodation will help you
return to work.
Notify Sedgwick when you physically return to work. If your
short‑term disability benefits have ended and you have
not returned to work or communicated your intentions,
Sedgwick will notify you of your options, which include
requesting an extension of your leave or voluntarily
terminating employment. Failure to request an extension
may result in your employment being terminated.
If you return to work within 30 days of the end of your
approved disability period, you will be reinstated to the
disability coverage you had prior to your disability. If you
do not return to work within 30 days of the end of your
approved disability period, your coverage will lapse unless
you return to work and meet the active work requirement
within one year.
IF YOU RETURN TO WORK AND BECOME
DISABLED AGAIN
If you return to work for 30 calendar days or less of active
full‑time work (with or without medical restrictions) and
become disabled again from the same or a related condition
that caused the first period of disability, as determined
by Sedgwick, known as a “relapse/recurrent claim,” your
short‑term disability benefits will pick up where they
left off before you came back to work. There will be no
additional waiting period of seven calendar days. The
combined benefit duration for both periods of disability
will not exceed 25 weeks.
If you have returned to active full‑time work for more than
30 calendar days and then become disabled from the same
or a related cause, it will be considered a new disability, and
you may be able to receive up to 25 weeks of benefits. A new
benefit waiting period of seven calendar days will apply.
Intermittent leave. If you are able to return to work after
a period of short‑term disability and need to miss work
periodically for reasons related to your disability, notify
Sedgwick and your facility of your situation. Your treatment
may be covered under your prior short‑term disability
claim for up to 12 months from the date you return to work
from your short‑term disability claim. Salaried short‑term
disability generally pays 100% of your base pay for the
duration of your approved intermittent leave. You will not
need to use PTO for the absences.
Coverage during a leave of absence
or temporary layoff
If you are not working due to an approved non‑disability
leave of absence or temporary layoff, you will continue to
be eligible for short‑term disability benefits for 90 days
from your last day of work. Your eligibility for short‑term
disability benefits ends on the 91st day after the beginning
of your approved non‑disability leave or temporary layoff,
but is reinstated if you return to work within one year.
See Continuing benefit coverage if you go on a leave of
absence in the Eligibility and enrollment chapter for more
information, including details on paying for benefits while
on leave.
When coverage ends
Your short‑term disability coverage ends:
• At termination of your employment or on the date you
would otherwise lose eligibility
• On the last day of the pay period when your job status
changes from an eligible job status
• On the date of your death
• On the 91st day of an approved non‑disability leave of
absence (unless you return to work)
• On the 31st day following the end of your approved
disability period (unless you return to work), or
• When the benefit is no longer offered by the company.
If you leave the company and
are rehired
If you leave the company and return to work for the
company as a salaried associate, you will automatically be
reenrolled in the salaried short‑term disability plan.
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Truck driver
short-term
disability plan
Truck driver short‑term disability
How truck driver short‑term disability is administered
When you qualify for benefits
When benefits are not paid
Filing a claim
Your pay after filing a claim
Benefits determination
When benefits begin
Calculating your benefit
When short‑term disability benefit payments end
Returning to work
Coverage during a leave of absence or temporary layoff
When coverage ends
If you leave the company and are rehired
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This information does not create an express or implied contract of employment or any other contractual
commitment. Walmart may modify this information at its sole discretion without notice, at any time,
consistent with applicable law.
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Truck driver short-term disability plan
If pregnancy, a scheduled surgery, or an unexpected illness or injury keeps you off the job for an
extended period, this plan for truck drivers can protect part of your paycheck. When you can’t
work, the Walmart truck driver short‑term disability plan works for you.
RESOURCES
Find What You Need
Online
Other Resources
To file a claim or get more information
Go to One.Walmart.com/LOA
> mySedgwick
Call Sedgwick at 800-492-5678
To file a state benefit claim if you work
in any of the following areas:
Connecticut
Massachusetts
Washington, D.C.
Washington State
Go to paidleave.wa.gov
Go to paidleave.mass.gov
Call 833-344-7365
Go to dcpaidfamilyleave.dc.gov
Call 202-899-3700
Go to paidleave.wa.gov
Call 833-717-2273
Request an appeal of a denied
short‑term disability claim
Go to One.Walmart.com/LOA
> mySedgwick
Call Sedgwick at 800-492-5678
What you need to know about truck driver short-term disability
• If you are a full‑time truck driver, you are automatically enrolled in the truck driver short‑term disability plan.
Coverage is effective as of your date of hire and there is no cost to you.
• If you become disabled and are eligible to receive short‑term disability benefits, the truck driver short‑term
disability plan replaces 75% of your average day’s pay for up to 25 weeks, after an initial waiting period of seven
calendar days. (Different rules may apply to work‑related disabilities that qualify for workers’ compensation
through Walmart. See the chart titled Your truck driver short-term disability plan benefit for more information.)
• If your disability is due to pregnancy, the short‑term disability plan replaces 100% of your average weekly wage for
nine weeks, after an initial waiting period of seven calendar days. Generally no medical evidence is required for the
first nine weeks of maternity benefit payments. Additional benefits may be payable after the first nine weeks of
benefits if you experience medical complications during pregnancy or post‑partum. For details, see Maternity benefit
later in this chapter.
• The truck driver short‑term disability plan is not a benefit covered by ERISA and is not part of the Associates’ Health
and Welfare Plan.
• The claims and appeals procedures described in this chapter apply to the truck driver short‑term disability benefit
rather than the procedures in the Claims and appeals chapter.
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Truck driver short-term disability
You are automatically enrolled for coverage in the truck
driver short‑term disability plan as of your date of hire if
you are a full‑time truck driver. For details about eligible
job classifications, see the Enrollment and eligibility
dates by job classification section in the Eligibility and
enrollment chapter.
How truck driver short-term
disability is administered
Truck driver short‑term disability coverage is administered
by Sedgwick Claims Management Services, Inc. (Sedgwick)
and is provided by the company at no cost to you.
If you become disabled and eligible to receive short‑term
disability benefits, the truck driver short‑term disability
plan generally pays 75% of your average day’s pay for up to
25 weeks of an approved disability, after an initial waiting
period of seven calendar days of continuous disability. The
waiting period begins on your next scheduled work day after
your disability begins. (Disabilities that qualify for workers’
compensation through Walmart are treated differently, as
described in the chart titled Your truck driver short-term
disability plan benefit.)
If your disability is due to pregnancy, the truck driver
short‑term disability plan pays a maternity benefit of 100%
of your average day’s pay for the first nine weeks, after an
initial waiting period of seven calendar days. The waiting
period begins on your next scheduled work day after your
disability begins. If you remain disabled and eligible for
benefits after the first nine weeks of disability pay, the
truck driver short‑term disability plan will pay 75% of your
base pay for up to 16 additional weeks of benefit payments.
For your pay to continue during the initial waiting period of
seven calendar days, you may use paid time off (PTO). Truck
driver short‑term disability benefits begin the day after
the initial waiting period ends. PTO may not be used while
your claim decision is pending or while receiving short‑term
disability benefits.
If you are receiving short‑term disability at the end of the
PTO plan year, please refer to your location’s PTO policy for
payout and/or carryover information.
LEGALLY MANDATED PLANS
Short‑term disability benefits provided by individual states
and local governments generally have no impact on your
eligibility for the truck driver short‑term disability benefit
plan through Walmart.
The amount of the benefit under Walmart’s truck driver
short‑term disability plan will be reduced by the amount
of the legally mandated benefit Sedgwick estimates that
you are eligible to receive from the state or locality,
regardless of whether you apply for that legally mandated
benefit. The total benefits payable under the truck driver
short term disability plan to supplement your state or
locality benefit will not exceed the level of benefits
otherwise payable under the plan. Upon request, you will be
responsible for providing your award letter from the state
or locality to Sedgwick. If Sedgwick overestimated what
your mandated benefit would be, meaning that you were
paid less under the Walmart short‑term disability plan than
you were entitled to, you will be paid the difference in a
lump sum payment. If Sedgwick underestimated what your
mandated benefit would be, meaning that you were paid
more under the Walmart short‑term disability plan than
you were entitled to, you must repay any amount overpaid
to you. See The Plan’s right to recover overpayment and
The Plan’s right to salary/wage deduction in the Claims and
appeals chapter. If you do not repay overpaid amounts in
a timely manner, the company may deduct such amounts
from your paycheck or future disability benefit payments,
to the extent permitted by law.
When you qualify for benefits
To qualify for short‑term disability benefits through the
truck driver short‑term disability plan, you must meet the
following requirements:
• Your disability must have occurred on or after the
effective date of your coverage.
• You must be actively at work at the time of your
disability unless:
– You are not actively at work in certain cases of leave
of absence or layoff, as described later in this chapter
under Coverage during a leave of absence or temporary
layoff later in this chapter, or
– You are not actively at work because you experience
medical complications during pregnancy or post‑partum
and you have exhausted the nine‑week maternity
benefit period, as described later in this chapter under
Maternity benefit.
• You must submit medical evidence provided by a qualified
doctor that you are disabled as defined by the truck
driver short‑term disability plan (qualified doctors are
legally licensed physicians and practitioners who are not
related to you and who are performing services within
the scope of their licenses, including medical doctors
[M.D.], osteopaths [D.O.], nurse practitioners, physician’s
assistants, psychologists or other medical practitioners
whose services would be eligible for reimbursement under
the Associates’ Health and Welfare Plan).
• You must receive approval by Sedgwick of your claim.
Being actively at work means that you have earned wages in
the pay period immediately preceding your disability.
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Sedgwick may require written proof of your disability or
additional information before making a decision on your
claim. A statement by your physician that you are unable to
work does not by itself qualify you for short‑term disability
benefits. Approval of a medical leave of absence does not
constitute approval for short‑term disability benefits.
If your disability is caused by a mental illness
or substance use disorder, you are encouraged
to seek treatment within 30 days from the
first date of absence from a psychologist,
psychiatrist, or clinical social worker who holds
a Master of Social Work (M.S.W.), specializes
in mental health and substance use disorders,
and is licensed pursuant to state law. See the
Resources for Living chapter for information
on resources that are available if you are
experiencing the effects of a mental illness or
substance use disorder.
As defined by the truck driver short‑term disability
plan, “disabled” or “disability” means that you are unable
to perform the essential duties of your job for your
normal work schedule, or a license required for your job
duties has been suspended due to a mental or physical
illness or injury, or pregnancy. Benefits are payable
during a loss of license only while you are disabled and
pursuing reinstatement of your license on a timely basis.
Timely pursuit of reinstatement means you apply for
reinstatement when your condition meets the criteria
and you provide information and forms requested by the
licensing agency on a timely basis until your license is
reinstated. The determination of whether you are disabled
is made by Sedgwick on the basis of objective medical
evidence, which consists of facts and findings, including
but not limited to X‑rays, laboratory reports, tests,
consulting physician reports as well as reports and chart
notes from your physician. In addition, you must be under
the continuous care of a qualified doctor and following the
course of treatment prescribed. Loss of license by itself is
not sufficient for meeting the definition of disability.
If Sedgwick requests that you be examined by an
independent physician or other medical professional, you
must attend the exam to be considered for benefits. The
company will cover the cost of any such examination.
If your disability is the result of more than one cause, you
will be paid as if they were one (as described later in this
chapter under If you return to work and become disabled
again). The maximum benefit for any one period of disability
is limited to 25 weeks, after the initial waiting period.
If your disability is due to pregnancy, you will be deemed
to meet the definition of disability, and Sedgwick will not
require objective medical evidence as a condition for
approving your disability claim for the short‑term disability
maternity benefit, except in the following situations:
• You begin your leave of absence more than two weeks
before your estimated delivery date, or
• You do not begin your leave of absence immediately after
your delivery date.
The maternity benefit generally begins on the earlier of two
weeks before your estimated delivery date or the actual
date of delivery.
When benefits are not paid
Short‑term disability benefits will not be paid for an illness
or injury that:
• Arose before your coverage became effective
• Is not under the care of and being treated by a qualified
doctor
• Is caused by taking part in an insurrection, rebellion, or a
riot or civil disorder
• Resulted from your commission of or attempt to commit
a crime (e.g., assault, battery, felony, or any illegal
occupation or activity), or
• Resulted from doing any work for pay or profit.
Filing a claim
If you experience a disabling illness or injury, or are planning
to begin maternity leave, follow these steps:
STEP 1: Notify Sedgwick to apply for a leave of absence and
file a short‑term disability claim as soon as you know you will
be absent from work due to an illness, injury, or pregnancy.
Sedgwick will send you an initial packet providing the
information you will need and describing any actions
you will need to take. Notify your manager if your illness
or injury is related to your Walmart work, so a workers’
compensation claim can be initiated. Report your disability
online by going to One.Walmart.com/LOA > mySedgwick,
or call 800-492-5678.
Processing of your claim cannot begin until you have
stopped working. All claims for benefits under Walmart’s
truck driver short‑term disability plan must be submitted to
Sedgwick within 90 days of the date your disability begins.
Claims filed later than 90 days after the date of disability
may be denied unless Sedgwick determines you had good
cause for filing late.
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Associates who work in Connecticut, Massachusetts,
Washington, D.C., and Washington State are advised to
promptly apply to Sedgwick and to your state or locality for
state‑mandated state benefits. Refer to the Resources chart
at the beginning of the chapter for contact information.
Note that associates in Washington, D.C. will generally not
receive benefits for periods prior to the date of application
for benefits, except in emergency situations.
STEP 2: Tell your doctor’s office that it will be contacted
and asked to complete an attending physician’s statement
and provide medical information, including:
• Diagnosis
• Disability date and expected duration of disability
• Restrictions and limitations
• Physical and/or cognitive exam findings and test results
• Treatment plan, and
• Doctor visit notes.
You must sign a form authorizing your doctor to release this
information. This release will be included in the initial packet
that you receive from Sedgwick; however, if you are filing
your claim online, an electronic signature is accepted.
STEP 3: Follow up with your doctor to ensure that
information was forwarded to the disability administrator.
You may be required to provide written proof of your
disability or additional medical information before your
benefit payments begin.
If you become disabled, file your claim for
benefits promptly. A delay in filing could
result in delayed benefit payment, disruption
in your wages or the denial of your claim.
Your pay after filing a claim
Sedgwick will send you an initial packet when you file your
claim. You will have until the Medical Due Date, which
is stated in your initial packet, to provide the required
medical documentation. In order for your pay to continue
during the initial waiting period of seven calendar days,
you may use paid time off (PTO). Following your initial
waiting period of seven calendar days, your pay will
continue until your Medical Due Date; this pay is known
as “provisional pay.” Your pay will be suspended after your
Medical Due Date if the required medical documentation
has not been approved.
Be sure to provide the required medical documentation at
your earliest opportunity. If you do not meet the Medical
Due Date deadline, your pay will be suspended effective
the first day of the pay period in which it falls. If your claim
is approved, the approval will be effective as of the date
of your disability, and the provisional pay you received
while your claim was pending will count toward your
disability benefit.
If your claim is denied before the Medical Due Date due to
your medical circumstances not meeting the truck driver
short‑term disability plan’s definition of disability, your
provisional pay will be stopped and Walmart will commence
efforts to recover the amount paid to you for the period
following your illness or injury.
You will not receive provisional pay during any period when
a determination is being made regarding a relapse/recurrent
claim (see If you return to work and become disabled again
later in this chapter).
Benefits determination
Sedgwick makes a decision within 45 days of receiving
your properly filed claim. The time for a decision may be
extended for up to two additional 30‑day periods. You will
be notified in writing before any extension period that an
extension is necessary due to matters beyond Sedgwick’s
control. Those matters must be identified and you must
be given the date by which Sedgwick will make a decision.
If your claim is extended due to your failure to submit
information Sedgwick deems necessary to decide your
claim, the time for decision will be suspended as of the date
on which the notification of the extension is sent to you
until the date Sedgwick receives your response. If Sedgwick
approves your claim, the decision will contain information
sufficient to inform you of that decision.
If Sedgwick denies your claim, you will be sent a written
notification of the denial, which will include:
• Specific reasons for the decision
• Specific reference to the policy provisions on which the
decision is based
• A description of any additional material or information
necessary for you to perfect the claim and an explanation
of why such material or information is necessary
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• A description of the appeal procedures and time limits
• A statement that you have the right to obtain, upon
applicable to such procedures, and
• If an internal rule, guideline, protocol, or other similar
criteria was relied upon in making the denial, either:
request and free of charge, a copy of internal rules or
guidelines relied upon in making this determination, and
• A statement describing any appeal procedures offered by
– The specific rule, guideline, protocol, or other similar
the Plan.
criteria, or
– A statement that such a rule, guideline, protocol, or
other similar criteria was relied upon in making the
denial and that a copy will be provided free of charge to
you upon request.
APPEALING A DISABILITY CLAIM THAT HAS
BEEN FULLY OR PARTIALLY DENIED
If your claim for benefits is denied and you would like
to appeal, you must submit a written or oral appeal to
Sedgwick within 180 days of the denial. Your appeal should
include any comments, documents, records, or any other
information you would like considered.
For associates in states or localities with legally mandated
plans, such as Connecticut, Massachusetts, Washington,
D.C., and Washington State, you should submit your
appeal directly to the state or local government. If you
are appealing your Sedgwick claim, file your appeal with
Sedgwick as noted below.
Sedgwick will make a determination on your appeal within
45 days of the receipt of your appeal request. This period
may be extended by up to an additional 45 days if it is
determined that special circumstances require an extension
of time. You will be notified prior to the end of the 45‑day
period if an extension is required. If you are asked to provide
additional information, you will have 45 days from the date
you are notified to provide the information, and the time to
make a determination will be suspended until you provide
the requested information (or the deadline to provide the
information, if earlier).
If your appeal is denied in whole or in part, you will receive
a written notification of the denial that will include:
• The specific reason(s) for the adverse determination
• Reference to the specific plan provisions on which the
determination was based
• A statement describing your right to request copies, free
of charge, of all documents, records, or other information
relevant to your claim
VOLUNTARY SECOND APPEAL OF A TRUCK
DRIVER SHORT-TERM DISABILITY CLAIM
If your appeal is denied, you may make a voluntary second
appeal of your denial orally or in writing to Sedgwick. You
must submit your second appeal within 180 days of the
receipt of the written notice of denial. You may submit
any written comments, documents, records, and any
other information relating to your claim. The same criteria
and response times that applied to your first appeal, as
described earlier, are generally applied to this voluntary
second appeal.
All truck driver short‑term disability appeals (initial appeals
and voluntary second appeals) should be sent to:
Walmart Disability and Leave Service Center at Sedgwick
National Appeals Unit
P.O. Box 14748
Lexington, Kentucky 40512-4748
When benefits begin
If you are approved for short‑term disability benefits, the
benefit will begin after a waiting period of seven calendar
days. The waiting period begins on your next scheduled work
day after your disability begins. (Work‑related disabilities
that qualify for workers’ compensation through Walmart
may have different waiting periods under state law.)
In order for your pay to continue during the initial waiting
period of seven calendar days, you may use paid time off
(PTO). Truck driver short‑term disability benefits begin
after the initial waiting period. PTO may not be used while
receiving short‑term disability benefits (but see Your pay
after filing a claim earlier in this chapter for information
regarding provisional pay that may apply after your initial
waiting period of seven calendar days).
If you are receiving short‑term disability at the end of the
PTO plan year, please refer to your location’s PTO policy
for payout and/or carryover information.
You do not accrue additional PTO while you are receiving
short‑term disability benefits.
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Calculating your benefit
The amount of your short‑term disability benefit is based on:
• Your average day’s pay as of your last day worked.
• The duration of your disability.
If you become disabled and eligible to receive short‑term disability benefits, the truck driver short‑term disability plan
replaces 75% of your average day’s pay as of your last day before your disability for up to 25 weeks, after an initial waiting
period of seven calendar days. There is no maximum weekly benefit under the truck driver short‑term disability plan.
If you become disabled and eligible to receive short‑term disability benefits, the truck‑driver short‑term disability plan pays
benefits as described below.
YOUR TRUCK DRIVER SHORT‑TERM DISABILITY PLAN BENEFIT
Duration of your
disability
Up to 26 weeks
Your benefit is:
If your disability does not qualify for
workers’ compensation through Walmart
If you have a work-related disability that qualifies for workers’
compensation through Walmart
After an initial waiting period of
7 calendar days, 75% of your average
day’s pay. The waiting period begins on
your next scheduled workday after your
total disability begins.
You may use PTO during your first
7 calendar days of continuous disability.
For example, if your average day’s pay
over the week totals $1,000, 75% of
$1,000 is a $750 weekly benefit.
75% of your average day’s pay. The short‑term disability
benefit will pay 75% during the state workers’ compensation
waiting period, then workers’ compensation will pay
according to the state’s compensation rate. The short‑term
disability benefit will “top off” this pay to 75%. If the state
compensation rate is greater than 75%, you will not receive
additional benefits from Sedgwick.
For example, if your workers’ compensation benefit or
anticipated benefit is 66%, the short‑term disability benefit
will provide 9% of your wages.
Short‑term disability benefits are paid through your payroll
check, while workers’ compensation is paid through a separate
check except in the states of Texas and Wyoming, where the
entire benefit is included in the payment you receive from
Walmart.
If you are able to return to work after a period of short‑term disability and need to miss work periodically for reasons related to your
disability, notify Sedgwick and your facility of your situation. Your treatment may be covered under your prior short‑term disability claim
for up to 12 months from the date you return to work from your short‑term disability claim. Truck driver short‑term disability generally
pays 100% of your base pay for the duration of your approved intermittent leave. You will not need to use PTO for the absences.
NOTE: For associates who are eligible for legally mandated benefits (as noted in Legally mandated plans earlier in this chapter) as well as
benefits under the truck driver short‑term disability plan, the amount of the benefit under the truck driver short‑term disability plan will
be reduced by the amount of the state‑sponsored benefit.
If a benefit is payable for less than a week, your pay will be based on 75% of your average day’s pay multiplied by your regular work days
scheduled for each day you are disabled.
WORKERS’ COMPENSATION AND YOUR SHORT-TERM DISABILITY BENEFITS
Workers’ compensation and short‑term disability benefits are made as separate payments except in the states of Texas and
Wyoming, where the entire benefit is included in the payment you receive from Walmart.
If you are receiving workers’ compensation benefits for an unrelated injury or illness, any short‑term disability benefit for
which you are eligible will be reduced, or offset, by any workers’ compensation benefits you are eligible to receive.
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MATERNITY BENEFIT
Maternity benefits under the truck driver short‑term disability plan are as described here:
MATERNITY BENEFIT
Duration of benefit
Your benefit is:
Up to 9 weeks*
100% of your average day’s pay
after an initial waiting period of
7 calendar days
If you are eligible for legally mandated benefits in Connecticut;
Massachusetts; Washington, D.C.; and Washington State:
Legally mandated benefits are payable at the applicable state or
local government rate; the Walmart truck driver short‑term disability
maternity benefit will make up the difference between the state or
local government benefit and 100% of your average day’s pay after an
initial waiting period of 7 calendar days.
Maternity benefits under the truck driver short‑term disability plan begin on the 8th calendar day after
your eligible disability begins. You may use PTO during your first 7 calendar days of continuous disability.
* You may also be eligible for additional parental and family care pay equal to 100% of your average day’s pay. You cannot receive parental
pay and family care pay benefits while receiving short‑term disability plan maternity benefits. For more information, refer to the
Parental Pay Policy and Family Care Pay Policy on One.Walmart.com.
NOTE: For associates who are eligible for legally mandated benefits (as noted in Legally mandated plans earlier in this chapter)
as well as benefits under the truck driver short‑term disability plan, the amount of the benefit under the truck driver short‑term
disability plan will be reduced by the amount of the legally mandated benefit.
If you begin your short‑term disability leave on your delivery
date or up to two weeks before your expected delivery date,
you will be deemed to meet the plan’s definition of disability
and eligible for maternity disability benefits.
If you begin your leave later than your actual delivery date,
you must meet the plan’s definition of disability and will be
eligible for the non‑maternity disability benefits only.
If you experience medical complications during pregnancy
or post‑partum, benefits may be payable under the truck
driver short‑term disability plan after the end of the
nine‑week duration of maternity benefits if you continue to
meet the definition of disability. Benefits would be equal to
75% of your average day’s pay from week 10, up to 25 weeks
of benefit payments.
TAXES AND YOUR SHORT-TERM
DISABILITY BENEFIT
Benefits payable to you under the truck driver short‑term
disability plan are company‑provided, at no cost to you.
Because you do not make any contributions to the truck
driver short‑term disability plan, and you do not pay any
tax on the coverage that Walmart provides, any benefits
payable to you are subject to taxes. Walmart generally
withholds federal, state, local and Social Security taxes from
the amount of your benefit payments.
Walmart cannot guarantee the specific tax consequences
that will result from your receipt of benefits under the truck
driver short‑term disability plan. Walmart is not providing
legal advice. If you need an answer upon which you can rely,
you may wish to consult a tax advisor.
The truck driver short‑term disability plan has the right
to recover from you, and you must repay, any amount
overpaid to you for short‑term disability benefits under
this plan. See The Plan’s right to recover overpayment and
The Plan’s right to salary/wage deduction in the Claims and
appeals chapter. If you do not repay overpaid amounts in
a timely manner, the company may deduct such amounts
from your paycheck or future disability benefit payments,
to the extent permitted by law.
When short-term disability benefit
payments end
If you are receiving short‑term disability benefit payments
from the truck driver short‑term disability plan due to an
approved disability, your benefit payments from the plan
will end on the earliest of:
• The date you no longer meet the plan’s definition of disabled
• The date you fail to furnish the required proof of disability
when requested to do so by Sedgwick
• The date you are no longer under the continuous care and
treatment of a qualified doctor
• The date you refuse to be examined, if Sedgwick requires
an examination
• The last day of the maximum period for which benefits
are payable (25 weeks, or nine weeks for maternity
disability benefits)
• The date you are medically able and qualified to work in a
similar full‑time position offered to you by Walmart
• The date your employment terminates, or
• The date of your death.
When your short‑term disability benefits end and for any
reason you do not return to work, you must request an
extension of your leave (refer to the Resources chart at the
beginning of the chapter for contact information). Failure to
do so may result in your employment being terminated.
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Returning to work
Sedgwick will contact you before your expected return‑to‑
work date and advise you of steps you may need to take,
including getting a return‑to‑work certification completed
by your doctor. In some cases, your doctor may release
you to work with certain medical restrictions; any such
restrictions should be explicitly stated on your return‑to‑
work certification or written release. If you receive a return‑
to‑work certification containing medical restrictions, you
may be subject to a review to determine whether a job
adjustment or accommodation will help you return to work.
Notify Sedgwick when you physically return to work. If your
short‑term disability benefits have ended and you have
not returned to work or communicated your intentions,
Sedgwick will notify you of your options, which include
requesting an extension of your leave or voluntarily
terminating employment. Failure to request an extension
may result in your employment being terminated.
If you return to work within 30 days of the end of your
approved disability period, you will be reinstated to the
disability coverage you had prior to your disability. If you
do not return to work within 30 days of the end of your
approved disability period, your coverage will lapse unless
you return to work and meet the active work requirement
within one year.
IF YOU RETURN TO WORK AND BECOME
DISABLED AGAIN
If you return to work for 30 calendar days or less of active
full‑time work (with or without medical restrictions) and
become disabled again from the same or a related condition
that caused the first period of disability, as determined
by Sedgwick, known as a “relapse/recurrent claim,” your
short‑term disability benefits will pick up where they
left off before you came back to work. There will be no
additional waiting period of seven calendar days. The
combined benefit duration for both periods of disability will
not exceed 25 weeks.
If you have returned to active full‑time work for more than
30 calendar days and then become disabled from the same
or a related cause, it will be considered a new disability, and
you may be able to receive up to 25 weeks of benefits. A new
benefit waiting period of seven calendar days will apply.
If you return to active full‑time work for any number of
calendar days and then become disabled from a new and
unrelated cause, it will be considered a new disability, and
you may qualify for up to 25 weeks of benefits. A new
benefit waiting period of seven calendar days will apply.
Intermittent leave. If you are able to return to work after
a period of short‑term disability and need to miss work
periodically for reasons related to your disability, notify
Sedgwick and your facility of your situation. Your treatment
may be covered under your prior short‑term disability claim
for up to 12 months from the date you return to work from
your short‑term disability claim. Truck driver short‑term
disability generally pays 100% of your average day’s pay for
the duration of your approved intermittent leave. You will
not need to use PTO for the absences.
Coverage during a leave of absence
or temporary layoff
If you are not working due to an approved non‑disability
leave of absence or temporary layoff, you will continue to
be eligible for short‑term disability benefits for 90 days
from your last day of work. Your eligibility for short‑term
disability benefits ends on the 91st day after the beginning
of your approved non‑disability leave or temporary layoff,
but is reinstated if you return to work within one year.
See Continuing benefit coverage if you go on a leave of
absence in the Eligibility and enrollment chapter for more
information, including details on paying for benefits while
on leave.
When coverage ends
Your short‑term disability coverage ends:
• At termination of your employment or on the date you
otherwise lose eligibility
• On the last day of the pay period when your job status
changes from an eligible job status
• On the date of your death
• On the 91st day of an approved non‑disability leave of
absence (unless you return to work)
• On the 31st day following the end of your approved
disability period (unless you return to work), or
• When the benefit is no longer offered by the company.
If you leave the company and
are rehired
If you leave the company and return to work for the
company as a full‑time truck driver, you will automatically
be reenrolled in the truck driver short‑term disability plan.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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Full-time hourly
and salaried
long-term disability
The LTD plans
When you qualify for LTD benefits
Filing an LTD claim
When benefits are not paid
When LTD benefits begin
Calculating your benefit
If you are disabled and working
When LTD benefit payments end
If you return to work and become disabled again
Coverage during a leave of absence or temporary layoff
When coverage ends
If you leave the company and are rehired
If you lose and then regain eligibility or drop coverage and reenroll
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This information is intended to be a summary of your benefits and may not include all policy provisions. If
there is a discrepancy between this document and the policy issued by The Lincoln National Life Insurance
Company (Lincoln) regarding the calculation of benefits and limitations under the policy, the terms of the
policy will govern. You may obtain a copy of this policy by contacting Lincoln.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Full-time hourly and salaried long-term disability
If you become disabled and can’t work, the company’s long‑term disability plan can help. When
you enroll, the plan works with other benefits you get during a disability to replace part of your
paycheck.
RESOURCES
Find What You Need
Online
Other Resources
Get more details or file a claim
Go to One.Walmart.com/LOA >
mySedgwick
Call Lincoln at 877-353-6404
What you need to know about full-time hourly and salaried
long-term disability
• Walmart offers a long‑term disability (LTD) plan and also an LTD enhanced plan. If you are an employee of Walmart
and classified as a full‑time hourly or management associate in Walmart’s payroll system, you are eligible to enroll in
either plan.
• The LTD plans work with certain other benefits you receive while disabled to replace 50% of your average monthly
wage under the LTD plan or 60% of your average monthly wage under the LTD enhanced plan.
• If you enroll in either plan after your initial eligibility period, you will be required to submit Proof of Good Health
and may be required to undergo a medical exam at your own expense before you can be approved for coverage.
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The LTD plans
You are eligible to enroll in LTD coverage if you are a full‑time
hourly or management associate. For details about eligible
job classifications, see the Enrollment and effective
dates by job classification section in the Eligibility and
enrollment chapter.
cases of leave of absence or layoff, as described later in
this chapter under Coverage during a leave of absence or
temporary layoff. Being actively at work means you have
worked hours in the immediately preceding pay period if
you are an hourly associate or have earned wages if you
are a member of management. See the Eligibility and
enrollment chapter for details.
You can choose one of two available plans:
• The LTD plan. Provides 50% of your average monthly
wage up to a maximum monthly benefit of $15,000, minus
the amount of certain other benefits or income you are
eligible to receive, after your benefit waiting period if you
become disabled as defined by the plan.
• The LTD enhanced plan. Provides 60% of your average
monthly wage up to a maximum monthly benefit of
$18,000, minus the amount of certain other benefits or
income you are eligible to receive, after your benefit
waiting period if you become disabled as defined by
the plan.
Both plans are insured by Lincoln. For information about
your waiting period, see When LTD benefits begin later in
this chapter. For information about your average monthly
wage or other income or benefits that may reduce your
benefit, see Calculating your benefit and Other benefits or
income that reduces LTD benefits later in this chapter.
The date your coverage begins depends on when you enroll
for coverage:
• If you enroll during your initial enrollment period, your
coverage begins on your effective date, as detailed in the
Eligibility and enrollment chapter.
• If you enroll upon transferring from one eligible job
classification to another, your coverage begins on your
effective date. See the Eligibility and enrollment chapter
for information on your transition enrollment period and
your effective date.
• If you enroll at any time after your initial enrollment
period, you will be considered a late enrollee and required
to submit Proof of Good Health. You may be required to
undergo a medical exam at your own expense before you
can be approved for coverage. If approved, your coverage
will be effective the first day of the following pay period
after approval is received from Lincoln. If you are not
approved, you will only be eligible to enroll in the LTD plan
or LTD enhanced plan during the next Annual Enrollment
or after a status change event.
If you are enrolled in the LTD plan or LTD enhanced plan,
you will be able to drop coverage only at Annual Enrollment
or after a status change event. If you later reenroll, you will
be treated as a late enrollee, as described above.
To receive benefits under the LTD plan or the LTD enhanced
plan, you must be actively at work at the time of your
disability unless you are not actively at work in certain
THE COST OF LTD COVERAGE
Your cost for LTD coverage is based on your biweekly
earnings, your age, and whether you select the LTD plan or
the LTD enhanced plan. Premiums are deducted from all
wages, including bonuses. Premium payments are waived for
LTD coverage during any period in which LTD benefits are
payable but premiums for other benefits will not be affected.
Walmart will not withhold premiums for such other benefits
from your LTD benefits. If, however, you receive any other
earnings, including bonuses, through the Walmart payroll
systems while you are receiving LTD benefits, your premiums
for all benefits will be withheld from those payments.
When you qualify for LTD benefits
Under the terms of the LTD plan and LTD enhanced plans,
“disability” or “disabled” generally means that, due to a
covered injury or sickness during the benefit waiting period
and for the next 24 months of disability, you are unable to
perform the material and substantial duties of your own
occupation, and after 24 months of benefit payments,
you are unable to perform, with reasonable continuity,
the material and substantial duties of any occupation for
which you are reasonably fitted by training, education,
experience, age, and physical or mental capacity. However,
if you are employed as a pilot, copilot, or crewmember of an
aircraft, “disability” or “disabled” means that, as a result of
an injury or sickness, you are unable to perform the material
and substantial duties of your own occupation under the
applicable Federal Aviation Administration fitness standards.
In determining whether you are disabled, for persons
other than pilots or copilots, Lincoln does not consider
employment factors, including interpersonal conflict in the
workplace, recession, job obsolescence, pay cuts, job sharing,
or loss of professional or occupational license or certification.
To qualify for LTD benefits:
• You must be unable to return to work after the initial
benefit waiting period of disability.
• You must continue to be under the appropriate care of a
qualified doctor (qualified doctors include legally licensed
physicians and practitioners who are not related to you and
are performing services within the scope of their licenses).
• Lincoln must receive and approve certification with
accompanying medical documentation of a disability
from your qualified doctor before benefits are
considered for payment.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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PRE-EXISTING CONDITION EXCLUSION
You will not receive LTD benefits for any disability or
partial disability which begins in your first 12 months after
your effective date of coverage if such disability or partial
disability is caused, partially or entirely, or results from a
pre‑existing condition. A “pre‑existing condition” means
any condition resulting from an injury or sickness for which
you were diagnosed or received treatment during the
three‑month period prior to your effective date. Under
the terms of the pre‑existing condition exclusion, you are
receiving “treatment” when you are consulting, receiving
care or services provided by or under the direction of a
physician, including diagnostic measures; being prescribed
drugs or medicines, whether you choose to take them or
not; and taking drugs or medicines.
If you change from the LTD plan (50% benefit) to the LTD
enhanced plan (60% benefit), the pre‑existing condition
exclusion will apply to the additional coverage amount. If
you had satisfied the pre‑existing condition requirement
of the LTD plan (50% benefit) and then suffer a disability
before you satisfy the pre‑existing condition exclusion of
the LTD enhanced plan (60% benefit), you will only receive
benefits under the LTD plan (50% benefit).
Filing an LTD claim
If you are on an approved short‑term disability claim and are
enrolled in LTD benefits, your claim will be automatically
transitioned from Sedgwick to Lincoln. You may also call
Lincoln at 877-353-6404 as soon as you know you will
need to use your LTD benefit. Lincoln will provide you with
additional information on how to complete your claim.
Associates receiving workers’ compensation benefits and
enrolled in the LTD plan or LTD enhanced plan may be
eligible for disability benefits after their benefit waiting
period has expired. Call Lincoln at 877-353-6404 to report
your LTD claim.
Claims are determined under the time frames and
requirements set out in the Claims and appeals chapter.
You have the right to appeal a claim denial. See the Claims
and appeals chapter for details.
When benefits are not paid
Benefits are not paid for any LTD claim due to:
• War, declared or undeclared, or any act of war
• Active participation in a riot
• The committing of or attempting to commit a felony or
misdemeanor, or
• Cosmetic surgery, unless such surgery is in connection
with an injury or sickness sustained while you are a
covered person.
No benefit is payable during any period of incarceration.
When LTD benefits begin
If you are approved by Lincoln for LTD benefits, they will
begin after your benefit waiting period: 26 weeks or the end
of your short‑term disability benefits, whichever is longer.
Paid time off (PTO) may not be used while receiving LTD
benefits. If you are receiving LTD benefits at the end of
the PTO plan year, refer to your location’s PTO policy for
payout and/or carryover information. You do not accrue
additional PTO while receiving LTD benefits.
IF YOU RETURN TO WORK DURING
YOUR WAITING PERIOD AND BECOME
DISABLED AGAIN
If you cease to be disabled and return to work full‑time
for a total of the specified number of calendar days (as
defined below) or less during a waiting period, the waiting
period will be suspended and you must meet the balance
of the waiting period if you become disabled again. If
you return to work for a total of more than the specified
number of calendar days while satisfying your benefit
waiting period, you must satisfy an entirely new benefit
waiting period if you again become disabled before you are
eligible to receive LTD benefits. The “specified number of
calendar days” means (i) 60 days for hourly associates and
hourly pharmacists (other than hourly pharmacists working
in California), and (ii) 180 days for salaried associates,
salaried pharmacists, hourly pharmacists working in
California, management, and pilots.
Calculating your benefit
The amount of your LTD benefit is based on:
• Your average monthly wage, and
• If you are enrolled in the LTD plan or the LTD enhanced plan.
AVERAGE MONTHLY WAGE
Length of
employment
How average monthly wage is
determined
Employed 12
months or more
Your earnings for the 26 pay periods
immediately prior to your last day
worked ÷ 12
For example, the average monthly wage
for an associate with pre‑disability
earnings of $36,000 for the prior 26 pay
periods is $3,000 ($36,000 ÷ 12).
Employed less
than 12 months
Pre‑disability earnings ÷ number of
months worked
For example, the average monthly wage
for an associate with pre‑disability
earnings of $21,000 for seven months of
work is $3,000 ($21,000 ÷ 7).
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Average monthly wage includes:
• Overtime
• Bonuses
• Paid time off (not including any previous disability
benefits), and
• Regular earnings for the 26 pay periods (52 if paid weekly)
prior to your last day worked. Any pay periods in which you
have no earnings are excluded, decreasing the number of
pay periods used for the calculation.
Commissions or any other extra compensation or fringe
benefits are not included.
If you have been employed less than 12 months, an
annualized average of earnings will be used.
Your LTD benefit is shown below:
YOUR LTD BENEFIT
If you are enrolled
Your coverage is
In the LTD plan
In the LTD
enhanced plan
50% of your average monthly wage
up to a maximum monthly benefit of
$15,000, minus the amount of certain
other benefits or income you are
eligible to receive (for example, Social
Security disability benefits)*
60% of your average monthly wage
up to a maximum monthly benefit of
$18,000, minus the amount of certain
other benefits or income you are
eligible to receive (for example, Social
Security disability benefits)*
* See Other benefits or income that reduces LTD benefits
for more information.
Your benefit will be no less than $50, for any month that
you are eligible to receive LTD benefits. The total of your
monthly disability payment, plus all earnings, cannot exceed
100% of your average monthly wage prior to your disability.
LTD benefits are paid biweekly, as long as you continue to be
disabled as defined by the LTD plans.
Lincoln has the right to recover, and you must repay, any
amount overpaid to you for LTD benefits under the LTD plan
or LTD enhanced plan.
TAXES AND YOUR LTD BENEFIT
You pay 100% of the costs of your LTD coverage with after‑
tax contributions. As such, benefits payable to you under
the LTD plans are not subject to income taxes.
OTHER BENEFITS OR INCOME THAT REDUCES
LTD BENEFITS
Your LTD benefit amount is reduced, or offset, by other
benefits or income you receive or are eligible to receive.
“Other income” includes any earnings from any form of
employment, including under any formal or informal sick
leave or salary continuation plans. Except with respect to
retirement benefits, “other benefits” only includes amounts
you (or, under certain circumstances, your family) are
entitled to as the result of the same disability for which your
LTD benefit relates. Examples of other benefits include
amounts from the following:
• Social Security disability insurance (including amounts your
family receives or is eligible to receive due to your disability)
• Social Security retirement benefits granted after
the date of disability (including benefits your family
receives or is eligible to receive due to your eligibility
for retirement benefits)
• Workers’ compensation
• Company‑related group insurance plans providing
disability benefits
• Company‑paid or partially paid individual policies providing
disability benefits to the extent such benefits, plus your
LTD benefit, exceed your average monthly wage
• No‑fault automobile insurance
• Any ongoing short‑term disability benefits payable
under Walmart short‑term disability coverage
(i.e., relapse‑related benefits)
• State disability payments
• Unemployment benefits, or
• Settlement or judgment, less associated costs of a lawsuit
that represents or compensates for your loss of earnings
or bodily function.
If any of the other benefits that reduce your LTD benefits
are subsequently adjusted by cost‑of‑living increases, your
LTD benefit will not be further reduced. Refer to the policy
for a complete list of offsets. You may obtain a copy of the
LTD policy by calling Lincoln at 877-353-6404.
REDUCTION OF LTD BENEFIT EXAMPLE
Annual salary: $36,000
Average monthly wage
Benefit amount (percentage of
average monthly wage, subject
to the monthly maximum)
Less estimated Social
Security disability benefit
Less dependent’s estimated
Social Security benefit
LTD Plan
(50%)
LTD Enhanced
Plan (60%)
$3,000
$1,500
$3,000
$1,800
‑ $750
‑$750
‑ $375
‑ $375
LTD payment (monthly)
$375
$675
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APPLYING FOR SOCIAL SECURITY
DISABILITY BENEFITS
You may be eligible to receive Social Security disability
benefits after you have been disabled for five months.
If your disability has lasted 12 consecutive months, or is
expected to, the LTD policy terms may require you to apply
for Social Security disability benefits. If the Social Security
Administration denies your application for benefits, you will
be required to follow the Social Security Administration’s
appeal process.
Failure to file for Social Security disability benefits could
result in your Social Security retirement benefits being
reduced when you reach the age of retirement. If you qualify
for Social Security disability or retirement benefits while you
are receiving benefits under the LTD plan and your Social
Security disability claim is approved retroactively, you must
reimburse Lincoln for any LTD benefits overpaid during the
period covered by the retroactive Social Security approval.
Lincoln may assist you in filing for Social Security disability
benefits. To be eligible for assistance, you must be receiving
a benefit from Lincoln.
If you are disabled and working
You may be eligible to receive disability benefits if you
are partially disabled. Under the Plan, “partial disability”
and “partially disabled” mean that, as a result of sickness
or injury, you are able to:
• Perform one or more, but not all, of the material and
substantial duties of your own or any occupation on a
full‑time or part‑time basis, or
• Perform all of the material and substantial duties of your
own occupation or any occupation on a part‑time basis, and
• Earn between 20% and 80% of your indexed pre‑disability
earnings.
“Pre‑disability monthly earnings” means your regular
monthly rate of pay in effect for the 26 regular pay
periods (52 if paid weekly) immediately prior to your
last day worked, divided by 12. Pre‑disability earnings
include overtime, bonuses, paid time off, vacation, illness
protection, and personal pay, but not commissions or other
fringe benefits or extra compensation. If you have worked
for less than 12 months with the company, your regular
monthly rate of pay will be based on the total earnings
you actually received while working for the company
immediately prior to the date you became disabled,
annualized and divided by 12.
“Indexed pre‑disability monthly earnings” means your
pre‑disability earnings increased annually by 7% or
the percentage change in the Consumer Price Index,
whichever is less.
Lincoln offers a work incentive benefit for the first three
months that you are partially disabled and working. You will
continue to receive the full amount of your monthly benefit
for the first three months if you are partially disabled,
unless your benefit and current monthly earnings exceed
your pre‑disability basic monthly earnings. Your monthly
benefit will be reduced by the excess amount so that the
monthly benefit plus your earnings do not exceed 100% of
your pre‑disability basic monthly earnings.
After the first three months that you are partially disabled
and working, the following calculation is used to determine
your monthly benefit for a partial disability.
DISABLED AND WORKING BENEFIT CALCULATION
[(A - B) ÷ A] x C = D
A
B
C
D
Your indexed pre‑disability monthly earnings
Your current partial monthly earnings
The monthly benefit payable if you were qualified
as disabled, less other income earnings
The disabled and working benefit payable
IF YOU PASS AWAY WHILE RECEIVING
LTD BENEFITS
Coverage under the LTD plans ends upon your death.
However, if you pass away while receiving LTD benefits, a
lump‑sum payment of $5,000 or three times your gross
monthly LTD benefit, whichever is greater, will be paid to
your surviving spouse/partner. If you are not survived by a
spouse/partner, the payment will be made to your surviving
children, including stepchildren and legally adopted
children, in equal shares. However, if any of these children
are minors or incapacitated, payment will be made on their
behalf to the court‑appointed guardian of the children’s
property. If you are not survived by a spouse/partner or
children, the payment will be made to your estate.
When LTD benefit payments end
LTD benefit payments end on the earliest of:
• The date you fail to furnish proof of continued disability
and regular attendance of a doctor
• The date you fail to cooperate in the administration of your
claim. For example: providing information or documents
needed to determine whether benefits are payable and/or
determining the benefit amount
• The date you refuse to be examined or evaluated at
reasonable intervals
• The date you refuse to receive appropriate available
treatment
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• The date you refuse a similar job with Walmart, paying
comparable wages, where workplace modifications or
accommodations are made to allow you to perform the
material and substantial duties of your job
• The date you are able to work in your own occupation on a
part‑time basis but choose not to
• The date your partial disability monthly earnings exceed
80% of your indexed pre‑disability earnings
• The date you no longer meet the plan’s definition
of disabled
• The last day of the maximum period for which benefits
are payable (see charts below), or
• The date of your death.
MAXIMUM DURATION OF LTD BENEFITS
Age when you
become disabled
Prior to age 62
Benefits duration
Until normal retirement age
(as listed below)
62
63
64
65
66
67
68
69 or older
48 months
42 months
36 months
30 months
27 months
24 months
21 months
18 months
SOCIAL SECURITY NORMAL RETIREMENT AGE
Year of birth
Normal retirement age
1937 or before
65
1938
1939
1940
1941
1942
65 + 2 months
65 + 4 months
65 + 6 months
65 + 8 months
65 + 10 months
1943 through 1954
66
1955
1956
1957
1958
1959
66 + 2 months
66 + 4 months
66 + 6 months
66 + 8 months
66 + 10 months
1960 or after
67
IF THE DISABILITY IS DUE TO MENTAL ILLNESS,
ALCOHOLISM, OR DRUG ADDICTION
To receive LTD benefits for more than 24 months for the
following disabilities, you must be confined in a hospital or
other facility licensed to provide medical care:
• Mental illness (excluding demonstrable, structural
brain damage)
• Any condition that results from mental illness
• Alcoholism, and
• Non‑medical use of narcotics, sedatives, stimulants,
hallucinogens, or similar substances.
When you are not confined to a hospital or other licensed
facility, there is a 24‑month lifetime benefit for these
disabilities unless you are fully participating in an extended
treatment plan for the condition that caused the disability,
in which case the benefit is payable for up to 36 months.
If you return to work and become
disabled again
If you return to work for less than six months of active
full‑time work and become disabled again from the same or a
related condition that caused the first period of disability, as
determined by Lincoln, known as a “relapse/recurrent claim,”
the recurrent disability will be part of the same disability.
Your LTD benefits will pick up where they left off before
you came back to work. There will be no additional waiting
period. The combined benefit duration for both periods of
disability will not exceed the maximum duration listed in the
chart to the left.
If you return to work as an active full‑time associate for
six months or more, any recurrence of a disability will be
treated as a new disability. A new benefit waiting period
must be completed.
Coverage during a leave of absence
or temporary layoff
Once your LTD coverage is effective and you are eligible
to file a claim for benefits, if you are not actively at work
due to an approved non‑disability leave of absence or
temporary layoff, you will continue to be eligible for LTD
benefits for 90 days from your last day of work. Your
eligibility for LTD benefits ends on the 91st day after your
approved non‑disability leave or temporary layoff begins,
but is reinstated if you return to active work status within
one year. See Continuing benefit coverage if you go on a
leave of absence in the Eligibility and enrollment chapter
for more information, including details on paying for
benefits while on leave.
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If you lose and then regain eligibility
or drop coverage and reenroll
If you lose eligibility and then regain eligibility or drop
coverage and reenroll within 30 days, you will automatically
be reenrolled for the same coverage you had prior to
losing eligibility or dropping coverage (or the most similar
coverage offered under the Plan).
If you lose eligibility and then regain eligibility or drop
coverage and reenroll after 30 days, you will be considered
newly eligible and may enroll for coverage under the time
periods and conditions described in the Eligibility and
enrollment chapter.
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When coverage ends
Your LTD coverage ends:
• At termination of your employment, unless you have
been absent due to disability during the 26‑week benefit
waiting period and any period during which premium
payments are waived
• On the last day of the pay period when your job status
changes from an eligible job status
• The last day of coverage for which premiums were paid,
if you fail to pay your premiums within 30 days of the date
your premium is due
• On the date you lose eligibility
• If you do not return to work after the last day of an
approved leave of absence
• When the benefit is no longer offered by the company, or
• On the date of your death.
In addition, coverage under the long‑term disability plan
would end when you drop your coverage, as follows:
• After a status change event: coverage ends on the
effective date of the event. See Status change events in
the Eligibility and enrollment chapter for information.
• At Annual Enrollment: coverage ends on December 31 of
the current year.
If you leave the company and
are rehired
If you leave the company and return to full‑time work
for the company within 13 weeks, you will automatically
be reenrolled for the same coverage plan you had prior
to leaving the company (or the most similar coverage
offered under the Plan). If you are automatically reenrolled
in LTD plan or LTD enhanced plan coverage and choose to
drop it after you return, you may do so within 60 days of
resuming employment.
If you return to full‑time work after 13 weeks, you will be
considered newly eligible and may enroll for coverage under
the time periods and conditions described in the Eligibility
and enrollment chapter.
Truck driver
long-term disability
The truck driver LTD plans
When you qualify for truck driver LTD benefits
Filing a truck driver LTD claim
When benefits are not paid
When truck driver LTD benefits begin
Calculating your benefit
If you are disabled and working
When truck driver LTD benefit payments end
If you return to work and become disabled again
Coverage during a leave of absence or temporary layoff
When coverage ends
If you leave the company and are rehired
If you lose and then regain eligibility or drop coverage and reenroll
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This information is intended to be a summary of your benefits and may not include all policy provisions.
If there is a discrepancy between this document and the policy issued by The Lincoln National Life Insurance
Company (Lincoln) regarding the calculation of benefits and limitations under the policy, the terms of the
policy will govern. You may obtain a copy of this policy by contacting the Plan.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Truck driver long-term disability
If a disability keeps you off the road and unable to work, this plan works with other benefits you
get to replace part of your paycheck. There are two long‑term disability (LTD) plans for truck
drivers that pay different levels of benefits.
RESOURCES
Find What You Need
Online
Other Resources
Get more details or file a claim
Go to One.Walmart.com/LOA > mySedgwick
Call Lincoln at 877-353-6404
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What you need to know about truck driver long-term disability
• Walmart offers truck drivers an LTD plan and also an LTD enhanced plan. If you are an associate of Walmart and
classified as a full‑time truck driver in Walmart’s payroll system, you are eligible to enroll in either plan. Each plan
offers a choice of full‑duration coverage or five‑year coverage.
• The truck driver LTD plans work with certain other benefits you receive while disabled to replace 50% of your
average monthly wage if you select the truck driver LTD plan or 60% of your average monthly wage if you select
the truck driver LTD enhanced plan.
• If you enroll in either plan after your initial enrollment period, you will have to submit Proof of Good Health, and you
may be required to undergo a medical exam at your own expense before you can be approved for coverage.
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The truck driver LTD plans
You are eligible to enroll in truck driver LTD coverage if you
are a full‑time truck driver. You can choose between two
coverage plans, each of which is available in two options:
• LTD plan
– Five‑year coverage
– Full‑duration coverage
• LTD enhanced plan
– Five‑year coverage
– Full‑duration coverage
The options under the truck driver LTD plan and LTD enhanced
plan pay benefits as described in the following chart.
Both plans are insured by Lincoln. For information about
your waiting period, see When truck driver LTD benefits
begin later in this chapter. For information about your
average monthly wage or other income or benefits that
may reduce your benefit, see Calculating your benefit and
Other benefits or income that reduces truck driver LTD
benefits later in this chapter.
TRUCK DRIVER LTD
Five-year
coverage
LTD PLAN
LTD ENHANCED PLAN
Pays 50% of average
monthly wage up to
a maximum monthly
benefit of $15,000,
minus the amount of
certain other benefits
or income you are
eligible to receive*
Pays 60% of average
monthly wage up to
a maximum monthly
benefit of $18,000,
minus the amount of
certain other benefits
or income you are
eligible to receive*
Both plans pay benefits for 60 months, unless the
amount of time shown in the Maximum duration
of truck driver LTD benefits chart (later in this
chapter) will result in a benefits duration of
less than 60 months, in which case the monthly
benefit will be payable for the lesser period.
The date your coverage is effective depends on when you
enroll for coverage:
• If you enroll during your initial enrollment period, your
coverage will be effective on your date of hire.
• If you enroll at any time after your initial enrollment
period, you will be considered a late enrollee and required
to submit Proof of Good Health. You may be required to
undergo a medical exam at your own expense before you
can be approved for coverage. If approved, your coverage
will be effective the first day of the following pay period
after approval is received from Lincoln. If you are not
approved, you will only be eligible to apply for enrollment
in the LTD plan or LTD enhanced plan during the next
Annual Enrollment or after a status change event.
• If you enroll in the five‑year coverage option and
subsequently decide to enroll in the full‑duration coverage
option, or if you enroll in the truck driver LTD plan and
subsequently decide to enroll in the truck driver LTD
enhanced plan, you will be considered a late enrollee and
required to provide Proof of Good Health before you can
be approved for coverage. Your coverage will be effective
the first day of the pay period after People Services
receives approval from Lincoln.
If you are enrolled in the LTD plan or LTD enhanced plan,
you will be able to drop coverage only at Annual Enrollment
or after a status change event. If you later reenroll, you will
be treated as a late enrollee, as described above.
To receive benefits under the LTD plan or the LTD
enhanced plan, you must be actively at work at the time of
your disability unless you are not actively at work in certain
cases of leave of absence or layoff, as described later in
this chapter under Coverage during a leave of absence or
temporary layoff. Being actively at work means you have
worked hours in the immediately preceding pay period if
you are an hourly associate or have earned wages if you
are a member of management. See the Eligibility and
enrollment chapter for details.
LTD PLAN
LTD ENHANCED PLAN
THE COST OF TRUCK DRIVER LTD COVERAGE
Full-
duration
coverage
Pays 50% of average
monthly wage up to
a maximum monthly
benefit of $15,000,
minus the amount of
certain other benefits
or income you are
eligible to receive*
Pays 60% of average
monthly wage up to
a maximum monthly
benefit of $18,000,
minus the amount of
certain other benefits
or income you are
eligible to receive*
Both plan options pay benefits for the amount
of time shown in the Maximum duration of
truck driver LTD benefits chart (later in this
chapter).
* See Calculating your benefit and Other benefits or income
that reduces truck driver LTD benefits (later in this chapter)
for more information.
Your cost for truck driver long‑term disability coverage
is based on your biweekly earnings and the type of truck
driver LTD coverage you select. Premiums are deducted
from all wages, including bonuses. Premium payments for
truck driver LTD coverage are waived during any period for
which truck driver LTD benefits are payable but premiums
for other benefits will not be affected. Walmart will not
withhold premiums for such other benefits from any truck
driver LTD benefit payments you receive. If, however, you
receive any other earnings, including bonuses, through
the Walmart payroll systems while you are receiving truck
driver LTD benefits, including bonuses and wages earned
while partially disabled, your premiums for all benefits will
be withheld from those payments.
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When you qualify for truck driver
LTD benefits
Under the terms of the truck driver LTD plans, “disability”
or “disabled” means that, due to an injury or sickness,
during the benefit waiting period and for the next 24
months of disability, you are unable to perform the material
and substantial duties of your own occupation, or you lose
medical certification in accordance with the Federal Motor
Carrier Safety Regulations. After 24 months of benefit
payments, “disability” or “disabled” means that you are
unable to perform, with reasonable continuity, the material
and substantial duties of any occupation for which you are
reasonably fitted by training, education, experience, age,
and physical or mental capacity.
In determining whether you are disabled, Lincoln does
not consider employment factors, including interpersonal
conflict in the workplace, recession, job obsolescence, pay
cuts, job sharing or loss of professional or occupational
license or certification for reasons other than a covered
injury or sickness.
To qualify for truck driver LTD benefits:
• You must be unable to return to work after the initial
benefit waiting period of disability.
• You must continue to be under the appropriate care of a
qualified doctor (qualified doctors include legally licensed
physicians and practitioners who are not related to you and
are performing services within the scope of their licenses).
• Lincoln must receive and approve certification with
accompanying medical documentation of a disability
from your qualified doctor before benefits are considered
for payment.
If you enroll for coverage after your initial enrollment
period and file a claim within the first two years of your
coverage approval date, Lincoln has the right to reexamine
your Proof of Good Health questionnaire. If material facts
about you are found to have been stated inaccurately,
the true circumstances will be used to determine if your
coverage should be in effect and for what amount, and your
premium may be adjusted.
PRE-EXISTING CONDITION EXCLUSION
You will not receive truck driver LTD benefits for any
disability or partial disability which begins in your first
12 months after your effective date of coverage if such
disability or partial disability is caused, partially or entirely,
or results from a pre‑existing condition. A “pre‑existing
condition” means any condition resulting from an injury
or sickness for which you were diagnosed or received
treatment during the three‑month period prior to your
effective date. Under the terms of the pre‑existing condition
exclusion, you are receiving “treatment” when you are
consulting, receiving care or services provided by or under
the direction of a physician, including diagnostic measures;
being prescribed drugs or medicines, whether you choose to
take them or not; and taking drugs or medicines.
If you change from the five‑year duration coverage to the
full‑duration coverage under either of the truck driver LTD
plans, or if you change from the truck driver LTD plan to the
truck driver LTD enhanced plan, the pre‑existing condition
exclusion will apply to the additional duration or level of
benefits, as applicable. In this scenario, if you had satisfied
the pre‑existing condition requirement of the five‑year
duration coverage option or the truck driver LTD plan and
then suffer a disability before you satisfy the pre‑existing
condition exclusion of the full‑duration coverage option
or truck driver LTD enhanced plan, you will only receive
benefits under the five‑year duration coverage plan or
truck driver LTD plan, as applicable.
Filing a truck driver LTD claim
If you are on an approved short‑term disability claim and are
enrolled in LTD benefits, your claim will be automatically
transitioned from Sedgwick to Lincoln. You may also call
Lincoln at 877-353-6404 as soon as you know you will need
to use your truck driver LTD benefit. Lincoln will provide you
with additional information on how to complete your claim.
Claims are determined under the time frames and
requirements set out in the Claims and appeals chapter. You
have the right to appeal a claim denial. See the Claims and
appeals chapter for details.
When benefits are not paid
Benefits are not paid for any truck driver LTD claim due to:
• War, declared or undeclared, or any act of war
• Active participation in a riot
• The committing of or attempting to commit a felony or
misdemeanor, or
• Cosmetic surgery, unless such surgery is in connection
with an injury or sickness sustained while you are a
covered person.
No benefit is payable during any period of incarceration.
When truck driver LTD benefits begin
If you are approved by Lincoln for truck driver LTD benefits,
they will begin after your benefit waiting period: 26 weeks
or the end of your short‑term disability benefits, whichever
is longer.
Paid time off (PTO) may not be used while receiving LTD
benefits. If you are receiving LTD benefits at the end of the
PTO plan year, refer to your location’s PTO policy for payout
and/or carryover information. You do not accrue additional
PTO while receiving LTD benefits.
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IF YOU RETURN TO WORK DURING
YOUR WAITING PERIOD AND BECOME
DISABLED AGAIN
If you cease to be disabled and return to work for a total of
60 calendar days or less during a waiting period, the waiting
period will be suspended and you must meet the balance
of the waiting period if you become disabled again. If you
return to work for a total of more than 60 calendar days
while satisfying your benefit waiting period, you must satisfy
an entirely new benefit waiting period if you again become
disabled before you are eligible to receive LTD benefits.
Your benefit will be no less than $50 for any month that
you are eligible to receive LTD benefits. The total of your
monthly disability payment, plus all earnings, cannot exceed
your average monthly wage prior to your disability.
Truck driver LTD benefits are paid biweekly, as long as
you continue to be disabled as defined by the truck driver
LTD plans.
Lincoln has the right to recover from you any amount that
is overpaid to you for truck driver LTD benefits under the
truck driver LTD plan or the truck driver LTD enhanced plan.
Calculating your benefit
The amount of your truck driver LTD is based on:
• Your average monthly wage, and
• Which truck driver LTD plan you’re enrolled in.
AVERAGE MONTHLY WAGE
Length of employment
How average monthly wage
is determined
Employed 12 months
or more
Employed less than
12 months
Your activity pay, mileage rate, and
bonuses, paid in the 26 pay periods
prior to your last day worked ÷ 12
Your activity pay, mileage rate,
and bonuses ÷ the number of
months worked
TAXES AND YOUR LTD BENEFIT
You pay 100% of the costs of your LTD coverage with after‑tax
contributions. As such, benefits payable to you under the
truck driver LTD plans are not subject to income taxes.
OTHER BENEFITS OR INCOME THAT REDUCES
TRUCK DRIVER LTD BENEFITS
Your truck driver LTD benefit amount is reduced, or offset,
by other benefits or income you receive or are eligible
to receive. “Other income” includes any earnings from
any form of employment, including under any formal or
informal sick leave or salary continuation plans. Except
with respect to retirement benefits, “other benefits” only
includes amounts you (or, under certain circumstances, your
family) are entitled to as the result of the same disability for
which your truck driver LTD benefit relates. Examples of
other benefits include amounts from the following:
Note that any pay periods in which you have no earnings are
excluded, decreasing the number of pay periods used for
the calculation.
• Social Security disability insurance (including amounts
your family receives or is eligible to receive due to
your disability)
Your truck driver long‑term disability benefit is shown below:
YOUR TRUCK DRIVER LONG‑TERM DISABILITY BENEFIT
• Social Security retirement benefits that are granted
after the date of disability (including benefits your family
receives or is eligible to receive due to your eligibility for
retirement benefits)
If you are enrolled
Your coverage is
• Workers’ compensation
In the truck driver
five‑year coverage LTD
plan or the truck driver
full‑duration coverage
LTD plan
In the truck driver
five‑year coverage
LTD enhanced plan
or the truck driver
full‑duration coverage
LTD enhanced plan
50% of your average monthly
wage up to a maximum monthly
benefit of $15,000, minus the
amount of certain other benefits
or income you are eligible to
receive (for example, Social
Security disability benefits)*
60% of your average monthly
wage up to a maximum monthly
benefit of $18,000, minus the
amount of certain other benefits
or income you are eligible to
receive (for example, Social
Security disability benefits)*
* See Other benefits or income that reduces truck driver
long-term disability benefits for more information.
• Company‑related group insurance plans providing
disability benefits
• Company‑paid or partially paid individual policies
providing disability benefits to the extent such benefits,
plus your truck driver LTD benefit, exceed your average
monthly wage
• No‑fault automobile insurance
• Any ongoing short‑term disability benefits payable
under Walmart short‑term disability coverage
(i.e., relapse‑related benefits)
• State disability payments
• Unemployment benefits, or
• Settlement or judgment, less associated costs of a lawsuit,
that represents or compensates for your loss of earnings
or bodily function.
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If any of the other benefits that reduce your LTD benefits
are subsequently adjusted by cost‑of‑living increases, your
LTD benefit will not be further reduced. Refer to the policy
for a complete list of offsets. You may obtain a copy of the
truck driver LTD policy by calling Lincoln at 877-353-6404.
EXAMPLE: REDUCTION OF TRUCK DRIVER LTD BENEFIT
LTD Plan
(50%)
LTD Enhanced
Plan (60%)
$3,000
$1,500
$3,000
$1,800
‑ $750
‑ $750
‑ $375
‑ $375
Average monthly wage
Benefit amount
(percentage of average
monthly wage, subject to
the monthly maximum)
Less estimated Social
Security disability benefit
Less dependent’s
estimated Social
Security benefits
LTD payment (monthly)
$375
$675
APPLYING FOR SOCIAL SECURITY
DISABILITY BENEFITS
You may be eligible to receive Social Security disability
benefits after you have been disabled for five months. If your
disability has lasted 12 consecutive months, or is expected to,
the truck driver LTD policy terms may require you to apply
for Social Security disability benefits. If the Social Security
Administration denies you benefits, you will be required to
follow the Social Security Administration’s appeal process.
Failure to file for Social Security disability benefits could
result in your Social Security retirement benefits being
reduced when you reach the age of retirement. If you
qualify for Social Security disability or retirement benefits
while you are receiving benefits under any of the truck
driver LTD plan options and your Social Security disability
claim is approved retroactively, you must reimburse Lincoln
for any LTD benefits overpaid during the period covered by
the retroactive Social Security approval.
Lincoln may assist you in filing for Social Security disability
benefits. To be eligible for assistance, you must be receiving
a benefit from Lincoln.
If you are disabled and working
You may be eligible to receive disability benefits if you are
partially disabled. Under the truck driver LTD plans, “partial
disability” and “partially disabled” mean that, as a result of
sickness or injury, you are able to:
• Perform one or more, but not all, of the material and
substantial duties of your own or any occupation on a
full‑ time or part‑time basis, or
• Perform all of the material and substantial duties of your
own occupation or any occupation on a part‑time basis, and
• Earn between 20% and 80% of your indexed pre‑disability
earnings.*
* See Disabled and working benefit calculation for more
information about indexed pre‑disability earnings.
Lincoln offers a work incentive benefit for the first three
months that you are partially disabled and working. You
will continue to receive the full amount of your monthly
benefit for the first three months if you are partially
disabled, unless your benefit and current monthly earnings
exceed your pre‑disability basic monthly earnings. Your
monthly benefit will be reduced by the excess amount so
that the monthly benefit plus your earnings do not exceed
100% of your pre‑disability basic monthly earnings.
After the first three months that you are partially disabled
and working, the following calculation is used to determine
your monthly benefit for a partial disability.
DISABLED AND WORKING BENEFIT CALCULATION
[(A - B) ÷ A] x C = D
A
B
C
D
Your indexed pre‑disability monthly earnings
Your current partial monthly earnings
The monthly benefit payable if you were qualified
as disabled, less other income earnings
The disabled and working benefit payable
“ Pre‑disability monthly earnings” means your activity pay,
mileage rate, and bonus in effect for the 26 pay periods
(52 if paid weekly) immediately prior to your last day
worked, divided by 12.
“ Indexed pre‑disability monthly earnings” means your
pre‑disability monthly earnings increased annually by 7%
or the percentage increase in the Consumer Price Index,
whichever is less.
IF YOU PASS AWAY WHILE RECEIVING TRUCK
DRIVER LTD BENEFITS
Coverage under the truck driver LTD plans ends upon
your death. However, if you pass away while receiving
truck driver LTD benefits, a lump sum payment of $5,000
or three times your gross monthly LTD benefit, whichever
is greater, will be paid to your surviving spouse/partner. If
you are not survived by a spouse/partner, the payment will
be made to your surviving children, including stepchildren
and legally adopted children, in equal shares. However, if
any of these children are minors or incapacitated, payment
will be made on their behalf to the court‑appointed
guardian of the children’s property. If you are not survived
by a spouse/partner or children, the payment will be made
to your estate.
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When truck driver LTD benefit
payments end
Truck driver LTD benefit payments end on the earliest of:
• The date you fail to furnish proof of continued disability
and regular attendance of a doctor
• The date you fail to cooperate in the administration of your
claim. For example: providing information or documents
needed to determine whether benefits are payable and/or
determining the benefit amount
• The date you refuse to be examined or evaluated at
reasonable intervals
• The date you refuse to receive appropriate available
treatment
• The date you refuse a similar job with Walmart, paying
comparable wages, where workplace modifications or
accommodations are made to allow you to perform the
material and substantial duties of your job
MAXIMUM DURATION OF TRUCK DRIVER LTD BENEFITS
Age when you
become disabled
Prior to age 62
Benefits duration
Until normal retirement age
(as listed below)
62
63
64
65
66
67
68
69 or older
48 months
42 months
36 months
30 months
27 months
24 months
21 months
18 months
• The date you are able to work in your own occupation on a
SOCIAL SECURITY NORMAL RETIREMENT AGE
part‑time basis but choose not to
• The date your partial disability monthly earnings exceed
80% of your indexed pre‑disability earnings
• The date you no longer meet the plan’s definition of disabled
• The last day of the maximum period for which benefits are
payable (see charts on the right), or
• The date of your death.
Year of birth
Normal retirement age
1937 or before
65
1938
1939
1940
1941
1942
65 + 2 months
65 + 4 months
65 + 6 months
65 + 8 months
65 + 10 months
FIVE‑YEAR COVERAGE
1943 through 1954
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Five‑year coverage pays benefits for 60 months unless the
amount of time shown in the Maximum duration of truck
driver LTD benefits chart on right will result in a benefits
duration of less than 60 months, in which case the monthly
benefit will be payable for the lesser period.
FULL‑DURATION COVERAGE
Full‑duration coverage pays benefits for the amount of time
shown in the Maximum duration of truck driver LTD benefits
chart on right.
1955
1956
1957
1958
1959
66 + 2 months
66 + 4 months
66 + 6 months
66 + 8 months
66 + 10 months
1960 or after
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IF THE DISABILITY IS DUE TO MENTAL ILLNESS,
ALCOHOLISM, OR DRUG ADDICTION
To receive truck driver LTD benefits for more than 24 months
for the following disabilities, you must be confined in a
hospital or other place licensed to provide medical care:
• Mental illness (excluding demonstrable, structural brain
damage)
• Any condition that results from mental illness
• Alcoholism, and
• Non‑medical use of narcotics, sedatives, stimulants,
hallucinogens, or similar substances.
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When you are not confined to a hospital or other licensed
facility, there is a 24‑month lifetime benefit for these
disabilities unless you are fully participating in an extended
treatment plan for the condition that caused the disability,
in which case the benefit is payable for up to 36 months.
If you return to work and become
disabled again
If you return to work for less than six months of active
full‑time work and become disabled again from the same or
a related condition that caused the first period of disability,
as determined by Lincoln, known as a “relapse/recurrent
claim,” the recurrent disability will be part of the same
disability. Your LTD benefits will pick up where they left off
before you came back to work. No additional waiting period
will be required. The combined benefit duration for both
periods of disability will not exceed the maximum duration
listed in the chart on the previous page.
If you return to work as an active full‑time associate for
six months or more, any recurrence of a disability will be
treated as a new disability. A new benefit waiting period
must be completed.
Coverage during a leave of absence
or temporary layoff
Once your truck driver LTD coverage is effective and you
are eligible to file a claim for benefits, if you are not actively
at work due to an approved non‑disability leave of absence
or temporary layoff, you will continue to be eligible for
truck driver LTD benefits for 90 days from your last day
of work. Your eligibility for truck driver LTD benefits ends
on the 91st day after your approved non‑disability leave or
temporary layoff begins, but is reinstated if you return to
active work status within one year. See Continuing benefit
coverage if you go on a leave of absence in the Eligibility
and enrollment chapter for more information, including
details on paying for benefits while on leave.
When coverage ends
Your truck driver LTD coverage ends:
• At termination of your employment, unless you have
been absent due to disability during the 26‑week benefit
waiting period and any period during which premium
payments are waived
• On the last day of the pay period when your job status
changes from an eligible job status
• The last day of coverage for which premiums were paid,
if you fail to pay your premiums within 30 days of the date
your premium is due
• On the date you lose eligibility
• If you do not return to work after the last day of an
approved leave of absence
• When the benefit is no longer offered by the company, or
• On the date of your death.
In addition, coverage under the truck driver long‑term
disability plan would end when you voluntarily drop your
coverage, as follows:
• After a status change event: coverage ends on the
effective date of the event. See Status change events in
the Eligibility and enrollment chapter for information.
• At Annual Enrollment: coverage ends on December 31 of
the current year.
If you leave the company and
are rehired
If you leave the company and return to full‑time work for
the company within 13 weeks, you will automatically be
reenrolled for the same coverage you had prior to leaving
the company (or the most similar coverage offered under
the Plan). If you are automatically reenrolled in truck driver
LTD plan or LTD enhanced plan coverage and choose to
drop it after you return, you may do so within 60 days of
resuming employment.
If you return to full‑time work after 13 weeks, you will be
considered newly eligible and may enroll for coverage under
the time periods and conditions described in the Eligibility
and enrollment chapter.
If you lose and then regain eligibility
or drop coverage and reenroll
If you lose eligibility and then regain eligibility or drop
coverage and reenroll within 30 days, you will automatically
be reenrolled for the same coverage you had prior to
losing eligibility or dropping coverage (or the most similar
coverage offered under the Plan).
If you lose eligibility and then regain eligibility or drop
coverage and reenroll after 30 days, you will be considered
newly eligible and may enroll for coverage under the time
periods and conditions described in the Eligibility and
enrollment chapter.
Claims and appeals
Deadlines to file a claim or bring legal action
Appealing an enrollment or eligibility status decision
Medical, pharmacy, Centers of Excellence, dental, and vision benefits claims process
Internal appeal process
Special appeal procedures for Centers of Excellence
Voluntary review
External appeal process for medical, pharmacy, or Centers of Excellence benefits
Other rights related to medical, pharmacy, Centers of Excellence, dental, vision, and short‑term
disability benefits
The Plan’s subrogation and reimbursement rights
Claims for benefits and right to appeal reduction, reimbursement, and subrogation decisions
HMO plan options’ claims and appeals procedures
PPO Plan option’s claims and appeals procedures
Accident and critical illness insurance claims process
Company‑paid life insurance, optional associate and dependent life insurance, business travel
accident insurance, and AD&D claims process
Claims and appeals process for disability coverage claims
Resources for Living benefits
International business travel medical insurance
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Claims and appeals
As a participant in the Associates’ Health and Welfare Plan, you have the right to appeal a decision
regarding Plan eligibility and benefits. This chapter describes the process and the deadlines for
appealing a claim that has been partially or fully denied in the areas of eligibility, medical, pharmacy,
dental, vision, HMO and PPO Plan options, life insurance, AD&D, disability, or critical illness and
accident insurance.
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RESOURCES
Find What You Need
Submit a claim for benefits
Appeal a denied claim
Appeal a decision on eligibility for
coverage or enrollment status
For medical, pharmacy, dental, and vision claims, see your plan ID card for the claims
address or call your health care advisor at the number on your plan ID card. Submit
Centers of Excellence claims to the administrator as shown in the Centers of Excellence
chart later in the chapter. Submit all other claims to the Plan’s third‑party administrators
or insurer, if applicable, as shown later in this chapter.
Submit appeals to the addresses and within the deadlines provided in this chapter for the
Plan’s third‑party administrators, People Services, or the insurer, depending on the nature
of your appeal. Your initial denial letter will also specify where and when to file an appeal.
Write to:
Walmart Total Rewards Benefits
Attn: Internal Appeals
508 SW 8th Street
Bentonville, Arkansas 72716-3500
Or fax to 888-715-4154
Or for COBRA appeals, write to:
WageWorks (COBRA Appeals)
P.O. Box 226591
Dallas, Texas 75222-6591
Designate an authorized
representative to submit appeals on
your behalf
Call the number on your plan ID card or call People Services at 800-421-1362
What you need to know about claims and appeals
• You have the right to appeal an adverse eligibility decision affecting your coverage.
• You have the right to appeal an adverse preauthorization decision regarding your requested benefits.
• You must submit claims for benefits directly to the third‑party administrator or provider of the Plan.
• You have the right to appeal a benefit claim that has been partially or fully denied.
• You can appoint another party to appeal on your behalf by completing the Plan’s authorized representative form.
• After a final decision of an appeal of a medical, pharmacy, or Centers of Excellence claim is made, you may have the
right to request an independent external review of the decision if your claim involves medical judgment.
• Decisions regarding enrollment, eligibility status, and questions related to eligibility waiting periods are not eligible
for external review, but are eligible for voluntary review under the Plan. In addition, for the medical, dental, and vision
plans, appeals denied for nonmedical administrative reasons (e.g., because you exceeded the Plan’s visit limits) are
eligible for voluntary review under the Plan.
• You have the right to bring legal action if a claim is denied on appeal, but only after you have exhausted the Plan’s
claims and appeals procedures.
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Deadlines to file a claim or bring
legal action
You must submit your claim to the Plan within 18 months.
Unless otherwise specified in the chapter describing the
applicable benefit, initial claims for benefits under the Plan
must be filed within 18 months from the date of service or
other date on which the right to make a claim first arises.
Since procedures for filing a claim or an appeal are different
for different benefit plans and third‑party administrators,
be sure to review the relevant section of this chapter for
detailed information.
You must meet all claim and appeal deadlines and “exhaust”
your administrative remedies before you may take other
legal action. You must complete the required claims and
appeals process described in this Claims and appeals chapter
before you may bring legal action or, for certain medical,
pharmacy, dental, or Centers of Excellence claims, pursue
external review. You may not file a lawsuit for benefits if the
initial claim or appeal is not made within the time periods set
forth in the claims procedures of the Plan. You can appoint
another party to file a claim or appeal on your behalf by
completing the Plan’s authorized representative form.
You have limited time to file a lawsuit claiming benefits.
If you have completed all required claims and appeals and
you want to file a lawsuit, you must file any lawsuit for
benefits within 180 days after the final decision on appeal
(whether by the Plan or after external review). You may not
file suit after the end of that 180‑day period. If you request
a voluntary review or, if applicable, an external review, the
time taken by the voluntary review or external review is
not counted against the 180 days you have to file a lawsuit.
However, you are not required to request a voluntary
review by the Plan or an external review of the decision on
appeal before filing a lawsuit.
BENEFITS MAY NOT BE ASSIGNED
You may not assign your legal rights, such as the right to
pursue an appeal, the right to request copies of certain
Plan‑related documents, the right to pursue any type
of litigation on your behalf, including but not limited
to litigation for payment of benefits, the right to pursue
litigation for breach of fiduciary duty, the right to pursue
litigation seeking equitable relief, or the right to pursue
litigation to recover any statutory penalties, or your rights
to any payments under this Plan. However, the Plan may
choose to remit benefit payments directly to health care
providers with respect to covered services, but only as
a convenience to you and only if you authorize the Plan
to do so. Health care providers are not, and shall not be
construed as, either “participants” or “beneficiaries” under
this Plan and have no rights to receive benefits from the
Plan or to exercise legal rights or pursue appeals or legal
causes of action on behalf of (or in place of) you or your
dependents under any circumstances.
Appealing an enrollment or
eligibility status decision
This section describes the appeal process that applies to
enrollment and eligibility only.
If you disagree with the Plan Administrator’s determination
regarding your enrollment or eligibility status, you have
365 days from your eligibility enrollment event to appeal
in writing to Total Rewards Benefits, attention Internal
Appeals, at the address in the Resources chart at the
beginning of this chapter.
Eligibility decisions regarding the transplant and weight
loss surgery benefit waiting period are determined under
the claims and appeals time frames for medical claims, as
described in the section that follows.
COBRA participants should send the appeal, in writing, to
WageWorks at the address in the Resources chart at the
beginning of this chapter.
Your appeal will be handled within 60 days from the date
it is received (30 days for COBRA appeals), unless an
extension is required.
The 60‑day period may be extended if it is determined that
an extension is necessary due to matters beyond the Plan’s
control. You will be notified prior to the end of the 60‑day
period if an extension or additional information is required.
Appeals of enrollment or eligibility decisions are not eligible
for external review but are eligible for voluntary review.
Medical, pharmacy, Centers of
Excellence, dental, and vision
benefits claims process
This section describes the claims process that will be used
for the following benefits only:
• Medical, pharmacy, and Centers of Excellence benefits
except for HMO plan and PPO Plan options; see HMO
plan options’ claims and appeals procedures and PPO
Plan option’s claims and appeals procedures claims and
appeals procedures later in this chapter
• Dental benefits (through Delta Dental)
• Vision benefits (through VSP), and
• A rescission of coverage, which is a cancellation of
coverage that has a retroactive effect, except where
cancellation of coverage is due to failure to pay required
contributions or premiums in a timely manner.
If you voluntarily choose to prenotify the third‑party
administrator of a scheduled medical service before you
receive treatment, and prenotification is not required, the
TPA’s response is nonbinding on the Plan and not subject
to appeal. However, if the Plan terms or policies, as applied
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by your TPA, require you or your provider to preauthorize
services and your request for preauthorization is denied,
that decision is subject to appeal. See The medical plan
chapter for more information on voluntary prenotification
and required preauthorization provisions. Contact your
TPA if you have questions about whether a service
requires preauthorization.
Refer to the respective chapters in this Associate
Benefits Book for information on filing your initial claim.
In many cases, initial claims will be submitted on your
behalf by your health care provider. Initial claims will be
determined by third‑party administrators as listed in the
chart below, which have been delegated authority to make
claim determinations.
TIME PERIODS FOR CLAIM DETERMINATIONS
The time period in which your claim is determined depends
on the type of claim.
Pre-service claims. The Plan requires prior authorization
for all Centers of Excellence services and certain other
services, as described in the Preauthorization section of
The medical plan chapter. For these benefits, you or your
provider must file a claim for approval before you receive
treatment, or your claim may not be paid. These are called
“pre‑service claims.”
Urgent care claims. If your pre‑service claim is urgent, your
claim will be decided under the time frames applicable to
urgent care. A claim is urgent where making a determination
under the normal time frames could seriously jeopardize
your life or health or your ability to regain maximum
function, or, in the opinion of a physician with knowledge
of your medical condition, would subject you to severe pain
that could not adequately be managed without the care or
treatment that is the subject of the claim.
Post-service claims. If you are filing a claim after you have
already received services, your claim is a post‑service claim.
If your claim arises when there is a reduction in ongoing
care, your claim is a concurrent care claim.
Concurrent care claims. If your claim arises when there is a
reduction in ongoing care, such as a reduction in the length
of a previously approved hospital stay or a reduction in
the number of previously approved physical therapy visits,
or if you request an extension of an ongoing course of
treatment, your claim is a “concurrent care claim.”
CLAIMS ADMINISTRATION: ROUTINE MEDICAL, PHARMACY, DENTAL, AND VISION
Medical
(For Centers of Excellence claims, see below)
Your third-party administrator (see your plan ID card)
• Including services performed at a Centers of Excellence facility
but not covered under the Centers of Excellence program and
transplant claims not required to be performed at Mayo Clinic.
• Mercy Arkansas Local Plan—HealthSCOPE Benefits will process
all claims.
• UnityPoint Local Plan—Precedence Inc. will handle prior
authorizations and HealthSCOPE Benefits will process all claims.
• Banner Local Plan—Aetna will process all claims.
• Oschsner Local Plan—HealthSCOPE Benefits will process all claims.
Pharmacy
Dental
Vision
OptumRx
Delta Dental
VSP
CLAIMS ADMINISTRATION: CENTERS OF EXCELLENCE
NOTE: If you are enrolled in a local plan, please call your health care advisor to be directed to the appropriate administrator.
Heart surgery
Cancer medical record review
Contigo Health
HealthSCOPE Benefits
Outpatient kidney dialysis or ESRD medical record review HealthSCOPE Benefits
Spine surgery
Hip and knee replacement
Transplant
Weight loss surgery
Contigo Health
Contigo Health
HealthSCOPE Benefits
Contigo Health
The chart titled Claims process and timing on the following page shows deadlines for claims determinations for these types
of claims.
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CLAIMS PROCESS AND TIMING
Urgent claims
Any claim for medical care or treatment
where making a determination under
the normal time frames could seriously
jeopardize your life or health or your ability
to regain maximum function, or, in the
opinion of a physician with knowledge of
your medical condition, would subject you
to severe pain that could not adequately
be managed without the care or
treatment that is the subject of the claim.
Pre-service claims
A claim for services that have not yet
been rendered and for which the Plan
requires prior authorization.
Post-service claims
A claim for services that already have
been rendered, or where the Plan does
not require prior authorization.
Notice will be sent as soon as possible, taking into account the medical
circumstances, and in no case later than 72 hours after receipt of the claim. Notice
will be provided regardless of whether the claim is approved or denied.
You may receive notice orally, in which case a written notice will be provided within
three days of the oral notice. If your urgent claim is determined to be incomplete,
you will receive a notice to this effect within 24 hours of receipt of your claim, at
which point you will have 48 hours to provide additional information.
If you request an extension of urgent care benefits beyond an initially determined
period and make the request at least 24 hours prior to the expiration of the original
determination, you will be notified within 24 hours of receipt of the request.
If your pre‑service claim is filed properly, a claims determination will be sent within
a reasonable period of time appropriate to the medical circumstances, but no later
than 15 days from receipt of the claim.
If an extension is necessary due to matters beyond the Plan’s control, this time may
be extended 15 days. You will receive notice prior to the extension that indicates
the circumstances requiring the extension and the date by which the Plan expects
to render a determination. If the extension is necessary to request additional
information, the extension notice will describe the required information, and you
will be given at least 45 days to submit the information. The Plan then will make its
determination within 15 days from the date the Plan receives your information, or,
if earlier, the deadline to submit your information.
If your pre‑service claim is improperly filed, you will be sent notification within five
days of receipt of the claim.
A notice of a denial of a post‑service claim will be sent within a reasonable time
period, but not longer than 30 days from receipt of the claim.
If an extension is necessary due to matters beyond the Plan’s control, this time may
be extended 15 days. You will receive notice prior to the extension that indicates
the circumstances requiring the extension and the date by which the Plan expects
to render a determination. If the extension is necessary to request additional
information, the extension notice will describe the required information, and you
will be given at least 45 days to submit the information. The Plan then will make its
determination within 15 days from the date the Plan receives your information, or, if
earlier, the deadline to submit your information.
Concurrent care claims
A claim related to a reduction of ongoing
services or a request to extend an
ongoing course of treatment.
You will be notified in advance of any decision to reduce or terminate coverage
for ongoing care so that you will be able to appeal the decision and obtain
a determination before the coverage is reduced or terminated, unless such a
reduction or termination is due to a Plan amendment or termination of the Plan.
NOTICE OF CLAIM DENIAL
• Notice regarding your right to bring legal action following
If your claim is denied, the denial notice will include the
following information:
• The specific reasons for the denial
• Reference to Plan provisions on which the denial was based
• Information regarding time limits for appeal
• A description of any additional information necessary to
consider your claim and why such information is necessary
• A statement that you have the right to obtain, upon
request and free of charge, a copy of internal rules or
guidelines relied upon in making this determination
• If your denial is based on medical necessity or similar
limitation, an explanation of this rule (or a statement
that it is available upon request), and
a denial on appeal.
For medical, pharmacy, Centers of Excellence, and vision
benefits, the denial also will include:
• Information sufficient to identify the claim involved,
including, as applicable, the date of service, health care
provider, and claim amount
– Upon written request, the Plan will provide you with the
diagnosis and treatment codes (and their corresponding
meanings) associated with any denied claim or appeal.
• The denial code and its meaning
• A description of the Plan’s standard for denying the claim
• Information regarding available internal and external
appeals, including how to initiate an appeal, and
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• The availability of any contact information for an
MAILING ADDRESSES FOR APPEALS
applicable office of health insurance consumer assistance
or ombudsman to assist you with the internal and external
appeals process.
SOME TYPES OF PAYMENT DISPUTES
ARE NOT CLAIM “DENIALS”
Not every situation in which there is a payment dispute
between the Plan and your health care provider will
be considered a claim for benefits under these claims
procedures that results in a denial notice or a right to
appeal. If a decision is limited to a question about the
amount owed by the Plan to a provider and does not affect
the amount you may owe to the provider, the dispute
generally will not fall under these procedures. This may
occur, for example, when a network provider disputes the
negotiated amount paid by the TPA or when a non‑network
provider disputes a payment from the TPA with respect to
a service for which the provider is prohibited under state
or federal law from billing you for the balance of unpaid
amounts. The provider may separately dispute this payment
to the TPA or Plan, but it is not a claim for your Plan
benefits under these procedures.
Internal appeal process
APPEALING A CLAIM THAT HAS BEEN FULLY
OR PARTIALLY DENIED
If a claim submitted by you (or on your behalf) has been
denied, you may request an appeal of the decision. In order
for your appeal to be considered, it must:
• Be in writing
• Be sent to the correct address (see Mailing addresses for
appeals on the right)
• Be submitted within 365 days of the date of the initial
denial (for medical, Centers of Excellence, and dental
claims) or 180 days (for pharmacy and vision claims), and
MEDICAL SERVICES
(Including services performed at a Centers of Excellence facility
but not covered under the Centers of Excellence program)
Refer to your plan ID card for the name of your third-party
administrator.
Aetna
BlueAdvantage
Administrators of
Arkansas
UMR
HealthSCOPE Benefits
UnitedHealthcare
Aetna
Attn: National Account CRT
P.O. Box 14463
Lexington, Kentucky 40512
855-548-2387
BlueAdvantage Administrators
P.O. Box 1460
Little Rock, Arkansas 72203‑1460
866-823-3790
UMR
P.O. Box 30546
Salt Lake City, Utah 84130‑0546
855-870-9177
HealthSCOPE Benefits
Attn: Appeals
P.O. Box 2359
Little Rock, Arkansas 72203
800-804-1272
UnitedHealthcare
National Appeals Service Center
P.O. Box 30575
Salt Lake City, Utah 84130‑0575
888-285-9255
CENTERS OF EXCELLENCE SERVICES
Note that there is a special claims and appeals process for certain
Centers of Excellence benefits. See details later in this chapter.
Contigo Health
• Heart, spine, and hip
and knee replacement
surgeries
• Weight loss surgery
Contigo Health
Centers of Excellence: Walmart
Attn: Appeals Coordinator
1755 Georgetown
Hudson, Ohio 44236
HealthSCOPE Benefits, Inc.
• Weight loss surgery at
Mercy Local Plan
• Cancer care
• Mayo Clinic
HealthSCOPE Benefits, Inc.
Attn: Appeals Coordinator
27 Corporate Hill Drive
Little Rock, Arkansas 72205
• Contain any additional information/documentation you
transplant appeals
would like considered.
If your appeal involves an urgent claim, please contact your
third‑party administrator for information about how to file
your claim orally.
Aetna and OptumRx allow two levels of review. The second
appeal must be submitted within 60 days of the date of the
first appeal denial. All other third‑party administrators have
one level of appeal.
PHARMACY
OptumRx
DENTAL
OptumRx
Attn: Appeals Coordinator
P.O. Box 25184
Santa Ana, California 92799
Delta Dental of Arkansas Delta Dental of Arkansas
When making an appeal, you must send your written
request for review of the initial claim to the third‑party
administrator that administers your claims, as listed in the
chart that follows.
VISION
VSP
Appeals Committee
P.O. Box 15965
Little Rock, Arkansas 72231‑5965
VSP
Member Appeals
3333 Quality Drive
Rancho Cordova, California 95670
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NOTE: Certain types of benefits offered
through Centers of Excellence, including
transplants, spine surgery, and hip and knee
replacement, are subject to special appeal
procedures, as described later in this chapter.
If you are seeking to appeal a decision related
to a benefit offered through a Center of
Excellence, please consult those procedures.
Your appeal will be conducted without regard to your
initial determination, by someone other than the party
who decided your initial claim. No deference will be
afforded to the initial determination, meaning the appeal
will be an independent determination regarding the claim.
You will have the opportunity to submit written comments,
documents or other information in support of your appeal.
You have the right to request copies, free of charge, of
all documents, records or other information relevant to
your claim. The third‑party administrator, on behalf of the
Plan, will provide you with any new or additional evidence
or rationale considered in connection with your claim
sufficiently in advance of the appeals determination date
to give you a reasonable opportunity to respond.
If your claim involves a medical judgment question, the
Plan will consult with an appropriately qualified health
care practitioner with training and experience in the field
of medicine involved. If a health care professional was
consulted for the initial determination, a different health
care professional will be consulted on appeal. Upon request,
the Plan will provide you with the identification of any
medical expert whose advice was obtained on behalf of the
Plan in connection with your appeal.
A final decision on appeal will be made within the time
periods specified in the chart that follows, depending on
the type of claim:
APPEAL PROCESS AND TIMING
Urgent claims
Pre-service
claims
Post-service
claims
You will be notified of the determination
as soon as possible, taking into account
the medical circumstances, but not later
than 72 hours after receipt of the claim
(36 hours for each of two Aetna appeals).
You will be notified of the determination
within a reasonable period of time, taking
into account the medical circumstances,
but no later than 30 days from the date
your request is received (15 days for each
of two Aetna appeals).
You will be notified of the determination
within a reasonable period of time, but
no later than 60 days from the date your
request is received (30 days for each of
two Aetna appeals).
If your claim is denied on appeal, you will receive a denial
notice that includes:
• The specific reasons for the denial
• Reference to Plan provisions on which the denial was based
• A statement describing your right to request copies, free
of charge, of all documents, records, or other information
relevant to your claim
• A statement that you have the right to obtain, upon
request and free of charge, a copy of internal rules or
guidelines relied upon in making this determination
• If your denial is based on a medical necessity or similar
limitation, an explanation of this rule (or a statement that it
is available upon request)
• A description of any voluntary review procedures available,
and
• Notice regarding your right to bring legal action following
a denial on appeal.
For medical, pharmacy, and Centers of Excellence benefits,
the denial will also include:
• Information sufficient to identify the claim involved,
including the date of service, health care provider, and
claim amount (if applicable)
– Upon written request, the Plan will provide you with the
diagnosis and treatment codes (and their corresponding
meanings) associated with any denied claim or appeal.
• The denial code and its meaning
• A description of the Plan’s standard for denying the claim
• Information regarding available internal and external
appeals, including how to initiate an appeal, and
• The availability of any contact information for an applicable
office of health insurance consumer assistance or
ombudsman to assist you with the internal and external
appeals process.
Special appeal procedures for
Centers of Excellence
Certain benefits offered under the Plan through Centers of
Excellence are subject to special appeal procedures. Those
special procedures are described below. Please review these
procedures carefully if you are seeking to appeal a claim
denial related to one of these benefits.
SPECIAL PROCEDURES FOR APPROVAL OF
A TRANSPLANT LOCATION OTHER THAN
MAYO CLINIC
As described in The medical plan chapter, all eligible
transplant recipients under the Centers of Excellence
program must undergo a pre‑transplant evaluation at
Mayo Clinic. For these transplants, Mayo Clinic will make
a recommendation regarding transplant services at
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Mayo Clinic. You may file a prior authorization request to
receive a transplant at a facility other than Mayo Clinic
if there is significant risk that travel to Mayo Clinic could
result in death. In addition, if Mayo Clinic recommends
that a transplant is not an appropriate medical course of
treatment or you are not an appropriate candidate, you may
file a prior authorization request with the Plan.
These requests will be considered by an Independent
Review Organization appointed by the Plan Administrator,
which may approve the request for transplant services at
a different facility.
The Independent Review Organization will not include
any employee of Walmart, Mayo Clinic, or a third‑party
administrator of the Plan. The Independent Review
Organization will review any pertinent medical files
reviewed or generated by Mayo Clinic, as well as any
additional materials you submit, and will consider your
condition, alternative courses of treatment, scientific
studies and evidence, other medical professionals’ opinions,
the investigational or experimental nature of the proposed
procedures, and the potential benefit of the transplant.
Send your written request for review of preauthorization
transplant claims to:
Walmart Total Rewards Benefits
Attn: Internal Appeals
508 SW 8th Street
Bentonville, Arkansas 72716-3500
800-421-1362
Or fax to 888-715-4154
If you are filing a claim for services at a facility other
than Mayo Clinic because there is significant risk that
travel to Mayo Clinic could result in death, you should
file as soon as possible. If you are filing a claim because
Mayo Clinic has determined that the transplant is not an
appropriate medical course of treatment, your claim must
be received by the Plan within 120 calendar days of Mayo
Clinic’s initial denial of transplant treatment. If the claim
is urgent, the Independent Review Organization will make
its determination within 72 hours after receipt of the claim
(otherwise, the Independent Review Organization will make
its determination within 15 days of receipt of the claim).
If the urgent claim is determined to be incomplete, you will
receive a notice within 24 hours of receipt of the claim, and
you will have 48 hours to provide additional information.
For non‑urgent claims, the deadline to decide the claim
may be extended 15 days, and the Independent Review
Organization will send a notice explaining the extension, if one
is necessary. If the extension is necessary to request additional
information, the extension notice will describe the required
information and you will be given at least 45 days to submit
the information. The Plan will make a determination within
15 days from the date the Plan receives your information, or,
if earlier, the deadline to submit your information.
If your claim is denied, you will have 180 days to request
internal review of the denial by the Independent Review
Organization. The Independent Review Organization will
decide a request for urgent review within 72 hours and
non‑urgent review within 30 days after receipt. You then
may appeal a denial of an internal review appeal under the
external appeal process described later in this chapter if
your claim involves medical judgment.
Cornea and intestinal transplants, and any other transplant
service or claim where treatment already has been
rendered, will be decided under the regular medical claims
and appeals procedures for post‑service claims outlined
earlier in this chapter.
SPECIAL PROCEDURES FOR APPROVAL OF
EXCEPTIONS TO PLAN COVERAGE TERMS
FOR SPINE SURGERY AND HIP AND KNEE
REPLACEMENT
As described in The medical plan chapter, spine surgery and
hip and knee replacements that are eligible to be performed
at a Centers of Excellence facility must be pre‑approved
by the administrator of the program and performed at
a Centers of Excellence facility in order for Centers of
Excellence benefits to be payable.
You may file a prior authorization request (a “pre‑service”
claim) to receive services at a non‑Centers of Excellence
facility and receive in‑network benefits if there is significant
risk that travel could result in paralysis or death, or where a
Centers of Excellence facility determines that the procedure
is not the appropriate medical course of treatment or that
you are not an appropriate candidate for surgery.
Pre‑service claims will be considered by Contigo Health, the
administrator of the Centers of Excellence for spine surgery
and hip and knee replacement, which may approve coverage
at the in‑network level for spine surgery or hip or knee
replacement at a non‑Centers of Excellence facility.
Contigo Health will utilize an Independent Review
Organization which will not include any associate of
Walmart or the Centers of Excellence facility for spine
surgery or hip or knee replacement. The Independent
Review Organization will review any pertinent medical
files that were reviewed or generated by the Centers
of Excellence facility, as well as any additional materials
you submit, and will consider your condition, alternative
courses of treatment, scientific studies and evidence,
other medical professionals’ opinions, the investigational
or experimental nature of the proposed procedures, and
the potential benefit the surgical procedure would have.
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Send your written request for a pre‑service exception to
the Plan’s coverage terms for spine surgery or hip or knee
replacement to:
Centers of Excellence: Walmart
Attn: Appeals Coordinator
1755 Georgetown
Hudson, Ohio 44236
treatment, scientific studies and evidence, other medical
professionals’ opinions, the investigational or experimental
nature of the proposed procedures, and the potential
benefit the surgical procedure would have.
Send your written request for a post‑service exception
to the Plan’s coverage terms for spine surgery or hip or
knee replacement to:
If you are filing a pre‑service claim for services at a
non‑Centers of Excellence facility because there is significant
risk that travel could result in paralysis or death, you should
file as soon as possible. If you are filing a pre‑service
claim because a Centers of Excellence facility determined
that the surgery is not an appropriate medical course of
treatment, your claim must be received by the Plan within
120 calendar days of the initial denial by the Centers of
Excellence facility.
If a pre‑service claim is urgent, Contigo Health will make
its determination within 72 hours after receipt of the claim
(otherwise, Contigo Health will make its determination
within 15 days of receipt of a pre‑service claim). If the
urgent claim is determined to be incomplete, you will
receive a notice within 24 hours of receipt of the claim, and
you will have 48 hours to provide additional information.
For non‑urgent claims, the deadline to decide the claim may
be extended 15 days, and Contigo Health will send a notice
explaining the extension. If the extension is necessary to
request additional information, the extension notice will
describe the required information and you will be given at
least 45 days to submit the information. Contigo Health will
make a determination within 15 days from the date Contigo
Health receives your information, or, if earlier, the deadline
to submit your information.
If you have already received surgical treatment because
your circumstances called for immediate surgery, without
which you would likely have suffered paralysis or loss of
life, you may request that the services you received at a
non‑Centers of Excellence facility be covered as in‑network
services (a “post‑service” claim).
Post‑service claims will be considered by an Independent
Review Organization appointed by the Plan Administrator,
which may approve coverage at the in‑network level for the
spine surgery or hip or knee replacement at a non‑Centers
of Excellence facility.
The Independent Review Organization will not include any
associate of Walmart, the Centers of Excellence facility for
spine surgery or hip or knee replacement, or a third‑party
administrator of the Plan. The Independent Review
Organization will review any pertinent medical files that
were reviewed or generated by the Centers of Excellence
facility, as well as any additional materials you submit,
and will consider your condition, alternative courses of
Walmart Total Rewards Benefits
Attn: Internal Appeals
508 SW 8th Street
Bentonville, Arkansas 72716-3500
800-421-1362
Or fax to 888-715-4154
You must file your claim within 120 calendar days of the
date of service.
If you file a post‑service claim, the Independent Review
Organization will make its determination within 30 days
of receipt of the post‑service claim. For post‑service
claims, the deadline to decide the claim may be extended
15 days, and the Independent Review Organization will
send a notice explaining the extension. If the extension
is necessary to request additional information, the
extension notice will describe the required information
and you will be given at least 45 days to submit the
information. The Independent Review Organization
will make a determination within 15 days from the date
the Independent Review Organization receives your
information, or, if earlier, the deadline to submit
your information.
If your claim is denied (whether it is a pre‑service claim
considered by Contigo Health or a post‑service claim
considered by an Independent Review Organization),
you will have 180 days to request that an Independent
Review Organization conduct an internal review of the
denial. The Independent Review Organization will decide
a request for urgent review of a pre‑service claim within
72 hours after receipt, non‑urgent review of a pre‑service
claim within 30 days after receipt, and review of a
post‑service claim within 60 days of receipt. You then
may appeal a denial of an internal review appeal under the
external appeal process described later in this chapter
if your claim involves medical judgment.
REQUESTING TO WAIVE THE ONE-YEAR
WAITING PERIOD FOR TRANSPLANT BENEFITS
If the treating physician certifies that, absent the
transplant, the individual’s death is imminent within
48 hours, the otherwise applicable 12‑month waiting period
for transplant benefits may be waived. To request this
waiver, the claimant must file a prior‑authorization request.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Send your request and supporting documentation to
Walmart People Services:
By email: ghappeal@wal-mart.com
By fax: 888-715-4154
By mail: Walmart Total Rewards Benefits
Attn: Internal Appeals
508 SW 8th Street
Bentonville, Arkansas 72716-3500
Your request will be treated as an urgent or pre‑service
claim. See the Appeal process and timing chart earlier in
this chapter for details on the time frames under which the
Plan Administrator will notify you of its determination in
response to your request.
Voluntary review
In situations described below, you may request a voluntary
review of an appeal that has been denied. Voluntary review is
optional. You are not required to request a voluntary review to
be treated as exhausting your administrative remedies.
REQUESTING A VOLUNTARY REVIEW
OF A DENIED APPEAL: ENROLLMENT OR
ELIGIBILITY STATUS DETERMINATIONS
(INCLUDING COBRA)
If you have additional information that was not in your
appeal, you may ask for a voluntary review of the decision
on your appeal within 180 days of the date on the appeal
denial letter. The same criteria and response times that
applied to your appeal are generally applied to this
voluntary level of review.
Send a written request for a voluntary appeal for enrollment
or eligibility status to:
Walmart Total Rewards Benefits
Attn: Voluntary Appeals
508 SW 8th Street
Bentonville, Arkansas 72716-3500
Or fax to 888-715-4154
See Deadlines to file a claim or bring legal action earlier in
this chapter regarding the deadline to bring legal action.
REQUESTING A VOLUNTARY REVIEW OF
AN APPEAL DENIED FOR ADMINISTRATIVE
REASONS: MEDICAL, DENTAL, AND
VISION APPEALS
You may request a voluntary review of the decision on your
appeal of a denied medical, dental, or vision benefit claim if
your appeal was denied for an administrative reason, such as
if you exceeded the number of allowed visits, rather than for
a medical judgment reason. You must file your request within
180 days of the date on the appeal denial letter. The same
criteria and response times that applied to your appeal are
generally applied to this voluntary level of review.
Send a written request for a voluntary appeal for
administrative denial to:
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Walmart Total Rewards Benefits
Attn: Voluntary Appeals
508 SW 8th Street
Bentonville, Arkansas 72716-3500
Or fax to 888-715-4154
External appeal process
for medical, pharmacy, or
Centers of Excellence benefits
If your internal appeal for medical, pharmacy, or Centers
of Excellence benefits under the Plan is denied based on
medical judgment, you may have the right to further appeal
your claim in an independent external review process.
Your external appeal will be conducted by an Independent
Review Organization not affiliated with the Plan. If this
Independent Review Organization overturns the Plan’s
decision, the Independent Review Organization’s decision will
be binding on the Plan and will be implemented immediately,
although the Plan may seek further review by a court in
appropriate cases. Your internal appeal denial notice will
include information about your right to file a request for
an external review as well as contact information. You must
file your request for external review within four months of
receiving your final internal appeal determination. Filing a
request for external review will not affect your ability to
bring a legal claim in court. When filing a request for external
review, you will be required to authorize the release of any
medical records that may be required to be reviewed for the
purpose of reaching a decision on the external review.
Send a written request for an external medical appeal
(including a request related to Centers of Excellence
benefits) to:
Walmart Total Rewards Benefits
Attn: External Appeals
508 SW 8th Street
Bentonville, Arkansas 72716-3500
800-421-1362
Or fax to 888-715-4154
Send a written request for an external pharmacy appeal to:
OptumRx
Attn: Appeals Coordinator
P.O. Box 25184
Santa Ana, California 92799
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Other rights related to medical,
pharmacy, Centers of Excellence,
dental, vision, and short-term
disability benefits
THE PLAN’S RIGHT TO REQUEST
MEDICAL RECORDS
The Plan has the right to request medical records for any
associate or covered individual.
THE PLAN’S RIGHT TO AUDIT
The Plan has the right to audit your claims, including claims
of medical providers. The Plan (or the applicable third‑party
administrator) may reduce or deny benefits for otherwise
covered services for all current or future claims with the
provider made on your behalf or a participant in any other
health and welfare plan administered by the third‑party
administrator based on the results of an audit. The Plan may
also reduce or deny benefits for otherwise covered services
for all current or future claims you file.
THE PLAN’S RIGHT TO RECOVER OVERPAYMENT
Payments are made in accordance with the provisions of
the Plan. If it is determined that payment was made for
an ineligible charge or that another plan or insurance was
considered primary or that any other circumstances have
occurred that resulted in the Plan paying greater benefits
than permitted or required under the Plan terms, the Plan
has the right to recover the overpayment. The Plan (or the
third‑party administrator or other service provider acting
on behalf of the Plan) will try to collect the overpayment
from the party to whom the payment was made.
However, the Plan reserves the right to seek recovery
of an overpayment from any participant, beneficiary, or
dependent. In addition, the Plan has the right to engage an
outside collection agency to recover overpayments on the
Plan’s behalf if the Plan’s collection effort is not successful.
The Plan may also bring a lawsuit to enforce its rights to
recover overpayments.
If an overpayment is made to a provider, the Plan (or any
third‑party administrator acting on behalf of the Plan)
may reduce, offset, or deny benefits, in the amount of the
overpayment, for otherwise covered services for current or
future claims with the provider on behalf of any participant,
beneficiary, or dependent in the Plan. If a provider to whom
an overpayment was made has patients who are participants in
other health and welfare plans administered by the third‑party
administrator, the third‑party administrator may reduce or
offset payments otherwise owed to the provider from such
other health plans by the amount of the overpayment.
YOUR RIGHT TO RECOVER OVERPAYMENT
If you overpay your contributions or premiums for any
coverage under the Plan (except COBRA), the Plan will
refund excess contributions or premiums to you upon
request. In this circumstance, any refunds you receive may
be offset by any benefits paid during this period by the Plan
if you or a dependent was not eligible for such coverage.
If you overpay your premiums for COBRA coverage under
the Plan, a request for refund of those excess premiums
should be made to the Plan’s COBRA administrator.
THE PLAN’S RIGHT TO
SALARY/WAGE DEDUCTION
To the extent that the Plan may recover from you or your
dependents all or part of benefits previously paid, such as
for benefits that are overpaid or for which you were not
entitled under the Plan terms, you shall be deemed, by
virtue of your enrollment in the Plan, to have agreed that
the company may deduct such amounts from your wages,
salary, or other compensation or benefits, and pay the
same to the Plan until recovery is complete. If you enroll
for coverage under the Plan, you are deemed to have
consented to the applicable payroll deductions for such
coverage. In addition, if you fail to affirmatively enroll or
reenroll during Annual Enrollment, you are deemed to have
consented to the automatic reenrollment described in the
Eligibility and enrollment chapter, including the applicable
payroll deductions.
The Plan’s subrogation and
reimbursement rights
If you or a covered dependent (a covered person) is injured
or otherwise harmed due to the conduct of another party
and the Plan pays benefits as a result of such injury or harm,
the Plan Administrator has the right to recover payments
it makes on the covered person’s behalf from the covered
person or any party responsible for compensating the
covered person for their illnesses or injuries. The legal term
for this right of recovery is “subrogation.” The Plan shall have
a first‑priority lien against any amounts the covered person
recovers from another responsible party or insurer for the
full amount of the benefits that are paid to or for the benefit
of the covered person as a result of the third‑party injury or
harm, and the Plan shall have a right to offset such benefit
amounts against future benefits due under the Plan.
The Plan has the right to do any of the following to enforce
its lien and right of reimbursement and recovery:
• Reduce or deny benefits otherwise payable by the Plan, and
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• Recover or subrogate 100% of the benefits paid or to be
paid by the Plan for covered persons, to the extent of any
and all of the following payments:
The Plan will not pursue reduction, reimbursement, or
subrogation where the injury or illness that is the basis of
the covered person’s recovery from any party results in:
– Any judgment, settlement, or payment made or to be
made because of an accident or malpractice (except
for malpractice that results in paraplegia/quadriplegia,
severe burns, total and permanent physical or mental
disability, or death), regardless of how such judgment,
settlement, or payment is characterized, including
payments by any other insurance, whether providing
third‑party coverage or first‑party coverage
– Any auto or recreational vehicle insurance coverage
or benefits, including uninsured/underinsured
motorist coverage
– Business medical and/or liability insurance coverage or
payments, and
– Attorney fees.
The Plan’s lien exists at the time the Plan pays any benefits
to or for the benefit of a covered person. If a covered
person files a petition for bankruptcy, the covered person
agrees that the Plan’s lien existed prior to the creation of
the bankruptcy estate.
Also note that:
• “Covered person” means any participant (as defined by
ERISA) or dependent of a participant who is entitled to
benefits under the Plan
• The Plan has first priority with respect to its right to
reduction, reimbursement, and subrogation
• The Plan has the right to recover interest on the amount
paid by the Plan because of the accident
• The Plan has the right to 100% reimbursement in a
lump sum
• The Plan is not subject to any state laws or equitable
doctrine, including the common fund doctrine, which
would purport to require the Plan to reduce its recovery by
any portion of a covered person’s attorney’s fees and costs
• The Plan is not responsible for the covered person’s
attorney’s fees, expenses, or costs
• The right of reduction, reimbursement, and subrogation
is based on the Plan language in effect at the time of
judgment, payment, or settlement
• The Plan’s right to reduction, reimbursement, and
subrogation applies to any funds recovered from another
party, by or on behalf of the estate of any covered
person, and
• The Plan’s right to first priority shall not be reduced due to
the covered person’s own negligence.
• Paraplegia or quadriplegia
• Severe burns
• Total and permanent physical or mental disability, or
• Death.
The Plan Administrator has the authority, in its sole
discretion, to determine to limit or not pursue the Plan’s
rights to reduction, reimbursement, or subrogation. For
more information, contact the Plan Administrator.
Whether a covered person has a “total and permanent
physical or mental disability” will be determined based on
criteria developed and applied by the Plan Administrator
in its sole discretion. One way of demonstrating total and
permanent physical or mental disability is for a covered
person to show that the covered person has qualified
for Social Security disability income benefits. The Plan
Administrator will consider claims for physical and mental
disability, even if the covered person does not qualify for
Social Security disability income benefits, under criteria
developed by the Plan Administrator.
Even in circumstances where the Plan is not prohibited from
seeking reduction, reimbursement, or subrogation based
on the exceptions described previously, the Plan’s right to
reduction, reimbursement, or subrogation will be limited to
no more than 50% of the total amount recovered by or on
behalf of the covered person from any party (which shall
not be reduced for the covered person’s attorney’s fees
or costs). The Plan requires all covered persons and their
representatives to cooperate to guarantee reimbursement
to the Plan from third‑party benefits. Failure to comply will
entitle the Plan to withhold benefits due to you under the
Plan. A covered person and their representatives must not
do anything to hinder reimbursement of overpayment to
the Plan after benefits have been accepted by the covered
person or their representatives.
The Plan’s rights to reduction, reimbursement, and
subrogation apply regardless of any allocation or designation
of the applicable settlement or award (e.g., pain and suffering
or medical benefits) and regardless of the specific claims
or causes of action being settled or adjudicated. The Plan’s
rights apply regardless of whether the covered person has
been made whole or fully compensated for the covered
person’s injuries and without regard to any state law or
equitable doctrine, such as the make whole doctrine, that
would limit the Plan’s right of recovery based whether the
covered person has been made whole, it being intended that
the Plan’s right of recovery is a right to first dollar recovery.
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Additionally, the Plan has the right to file suit on the covered
person’s behalf for the condition related to the medical
expenses to recover benefits paid or to be paid by the Plan.
• Identify the exception or limitation to the Plan’s right
to reduction, reimbursement, or subrogation that the
claimant believes applies to the case, and
To aid the Plan in its enforcement of its right of reduction,
recovery, reimbursement, and subrogation, a covered
person or their designated representative must, at the
Plan’s request and at its discretion:
• Take actions necessary to enable the Plan to exercise its
• Include documentation that will assist the Plan in
making its decision (e.g., medical and hospital records,
physician letters).
Send a written request for review of the initial claim for
benefits to:
rights of recovery
• Give information, or
• Provide the Plan with any requested information related to
the claim involved, including information with respect to
other insurance, judgments, payments, or settlements.
Failure to aid the Plan and to comply with such requests
may result in the Plan’s withholding or recovering benefits,
services, payments, or credits due or paid under the Plan.
Claims for benefits and right to
appeal reduction, reimbursement,
and subrogation decisions
The Plan’s decision to seek reduction, reimbursement, or
subrogation is a determination of benefits under the Plan and
may be appealed in accordance with the procedures below.
For purposes of the claims procedures specified below,
a “claim for benefits” means a request by a participant,
beneficiary, or dependent (“claimant”) to have the
benefits provided under the Plan not reduced through the
application of the Plan’s right to reduction, reimbursement,
or subrogation.
INITIAL CLAIM FOR BENEFITS
If a claimant receives a notice that benefits are subject to
reduction, reimbursement, or subrogation and the claimant
believes that the case falls within one of the exceptions or
limitations to the Plan’s right to reduction, reimbursement,
or subrogation, the claimant may file a claim for benefits
with the Plan.
A claimant may also designate an authorized representative
to submit claims for benefits or appeals on their behalf.
For an initial claim for benefits to be considered, it must:
• Be in writing
• Be sent to the correct address
• Be submitted within 12 months of the date of the notice
that a benefit is subject to reduction, reimbursement, or
subrogation
Walmart Total Rewards Benefits
Attn: Subrogation Review
508 SW 8th Street
Bentonville, Arkansas 72716-3500
Within a reasonable time, but no later than 30 days after the
initial claim for benefits is made, the Plan will provide written
notice of its decision. If the claim for benefits is partially or
fully denied, the notice will include the following information:
• The specific reasons for the denial
• Reference to provisions of the Plan on which the denial
was based
• A description of any additional material or information
necessary to perfect your claim for benefits and an
explanation of why such material or information is necessary
• A statement that the claimant has the right to obtain, upon
request and free of charge, a copy of internal rules or
guidelines relied upon in making the Plan’s determination
• A description of the Plan’s appeal procedures and the time
limits for appeal, and
• Notice regarding the claimant’s right to bring a court
action following a denial on appeal.
The 30‑day period may be extended for 15 days if it is
determined that an extension is necessary due to matters
beyond the Plan’s control. The Plan will notify the claimant
prior to the end of the 30‑day period if an extension or
additional information is required. If asked to provide
additional information, the claimant will have 45 days from
the date notified to provide the information. The time to
make a determination will be suspended until the claimant
provides the requested information (or the deadline to
provide the information, if earlier).
RIGHT TO APPEAL A CLAIM DENIAL
If a claim related to a reduction, reimbursement, or
subrogation decision is fully or partially denied, the claimant
may request an appeal of the decision. For the appeal to be
considered, it must:
• Be in writing
• Be sent to the correct address
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• Be submitted within 180 days of the date of the initial
denial, and
• Contain any additional information/documentation the
claimant would like considered.
Send a written request for an appeal to:
Walmart Total Rewards Benefits
Attn: Internal Appeals
508 SW 8th Street
Bentonville, Arkansas 72716-3500
Or fax to 888-715-4154
The appeal will be conducted without regard to the initial
determination by someone other than the party who
decided the initial claim for benefits. The claimant has the
right to request copies, free of charge, of all documents,
records, or other information relevant to the claimant’s
claim for benefits. The claimant also has the right to
submit written comments, documents, records, and other
information, which the Plan will take into account in making
its decision on appeal. In deciding any claim for benefits that
is based in whole or in part on a medical judgment, the Plan’s
claims fiduciary will consult with a health care professional
who has appropriate training and experience in the field of
medicine involved in the medical judgment. The health care
professional will be an individual who is neither an individual
who was consulted in connection with the Plan’s decision
on the initial claim for benefits, nor the subordinate of
the health care professional. If the advice of a health care
professional is obtained in deciding an appeal, the name of
the health care professional will be provided to the claimant
upon request, regardless of whether the Plan relied on the
advice. The Plan must provide the claimant written notice
of the Plan’s decision on review within 60 days following the
Plan’s receipt of your appeal.
If the claim for benefits is denied on appeal, the Plan will
provide a denial notice that includes:
• The specific reason(s) for the denial
• Specific reference to provisions of the Plan on which the
denial was based
• A statement describing the claimant’s right to request
copies, free of charge, of all documents, records, or other
information relevant to the claim for benefits
• A statement that the claimant has the right to obtain, upon
request and free of charge, a copy of internal rules or
guidelines relied upon in making this determination
• A description of available voluntary review procedures,
if any, and
• Notice regarding the claimant’s right to bring a court
action following a denial on appeal.
A CLAIM FOR BENEFITS IS THE EXCLUSIVE WAY
TO SEEK AN EXCEPTION TO THE PLAN’S RIGHT
OF REDUCTION AND RECOVERY
The only method by which a claimant can request the Plan
not to reduce benefits using the Plan’s rights of reduction
and recovery is to file a claim for benefits, following the
process described above. A claimant must complete the
required claims and appeals process described in these
claims procedures before bringing any legal action. A
claimant may not file a lawsuit for benefits if the initial claim
for benefits or appeal is not made within the time periods
set forth in these claims procedures. A claimant must file
any lawsuit for benefits within 180 days after the decision
on appeal. You may not file suit after that 180‑day period
expires.
HMO plan options’ claims
and appeals procedures
In some locations, Walmart offers health insurance coverage
through a health maintenance organization (HMO) as
part of the Associates’ Health and Welfare Plan. If you
participate in an HMO, the HMO will provide a benefit
booklet that, together with this document, will serve as the
Summary Plan Description for the HMO coverage and will
describe its claims and appeals procedures. Contact your
HMO for additional information.
PPO Plan option’s claims
and appeals procedures
In some locations, Walmart offers the PPO Plan as part of
the Associates’ Health and Welfare Plan. If you participate
in the PPO Plan, Aetna, the PPO Plan option’s third‑party
administrator, will provide a booklet that, together with this
document, will serve as the Summary Plan Description for
the PPO Plan coverage and describe its claims and appeals
procedures. Contact Aetna for additional information.
Accident and critical illness
insurance claims process
Accident and critical illness insurance claims should
be submitted within 60 days of the occurrence or
commencement of any covered accident or critical illness to:
Allstate Benefits
Walmart Claims Unit
P.O. Box 41488
Jacksonville, Florida 32203-1488
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You may also provide notice of claim as follows:
Online: allstatebenefits.com/mybenefits
By phone: 800-514-9525
By fax: 877-423-8804
Be sure to provide the following information for the
covered person:
• Name
• Walmart identification number (WIN), and
• Date the covered illness or accident occurred or
commenced.
You may request a claim form from Allstate Benefits or
visit One.Walmart.com or AllstateBenefits.com/Walmart
to obtain a copy. If you do not receive a claim form within
15 days of your request, you may send a notice of the claim
to Allstate Benefits by providing Allstate Benefits with a
statement of the nature and extent of the loss.
CRITICAL ILLNESS
When you submit a claim to Allstate Benefits and your claim
is denied, a notice will be sent within a reasonable time
period, but no later than 30 days after Allstate Benefits
receives the claim (filed in accordance with the Critical
Illness Certificate of Insurance). In special circumstances, an
extension of time may be needed to make a decision. In that
case, Allstate Benefits may take a 15‑day extension. You will
receive written notice of the extension before the end of
the 30‑day period.
If your claim is denied, your denial will consist of a written
explanation, which will include:
• The specific reasons for the denial
• Reference to provisions of the Plan on which the denial
was based
• Information regarding time limits for appeal
• A description of additional material or information, if any,
needed to perfect the claim and the reasons such material
or information is necessary
• A statement that you have the right to obtain, upon
request and free of charge, a copy of internal rules or
guidelines relied upon in making this determination
• If your denial is based on medical necessity or similar
limitations, an explanation of this rule (or a statement that
it is available upon request), and
• Notice regarding your right to bring a court action
following a denial on appeal.
APPEALING A CRITICAL ILLNESS CLAIM THAT
HAS BEEN FULLY OR PARTIALLY DENIED
You may appeal any denial of a claim for benefits by filing a
written request with Allstate Benefits. In connection with an
appeal, you may request, free of charge, all documents that
are relevant (as defined by ERISA) to your claim. You may also
submit with your appeal any comments, documents, records,
and issues that you believe support your claim, even if you
have not previously submitted such documentation. You may
have representation throughout the review procedure.
An appeal must be filed with Allstate Benefits in accordance
with the claim filing procedures described in your denial
letter within 180 days of receipt of the written notice of
denial of a claim. Allstate Benefits will render a decision no
later than 60 days after receipt of your written appeal. The
decision after your appeal will be in writing and will include:
• The specific reasons for the denial
• Reference to provisions of the Plan on which the denial
was based
• A statement that you have the right to receive, upon
request and free of charge, reasonable access to, and
copies of, all documents, records, and other information
relevant to the claim for benefits
• A statement that you have the right to obtain, upon
request and free of charge, a copy of internal rules or
guidelines relied upon in making this determination
• If your denial is based on medical necessity or similar
limitations, an explanation of this rule (or a statement that
is available upon request)
• A description of any voluntary review procedures offered
by the Plan and your right to obtain information about such
procedures, and
• A statement regarding your right to bring court action
following a denial on appeal.
You also will receive a notice if the claim on appeal is
approved. If your claim is denied, you have the right to bring
action in federal court in accordance with ERISA Section
502(a), but only after you have followed the Plan’s claims
and appeals procedures.
ACCIDENT INSURANCE
When you submit a claim to Allstate Benefits and your claim is
denied, a notice will be sent within a reasonable time period,
but no later than 90 days after Allstate Benefits receives the
claim (filed in accordance with the Accident Certificate of
Insurance). In special circumstances, an extension of time may
be needed to make a decision. In that case, Allstate Benefits
may require a 90‑day extension. You will receive written
notice of the extension before the end of the 90‑day period.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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If your claim is denied, your denial will consist of a written
explanation, which will include:
• The specific reasons for the denial
• Reference to provisions of the Plan on which the denial
was based
• Information regarding time limits for appeal
• A description of additional material or information, if any,
needed to perfect the claim and the reasons such material
or information is necessary
• A statement that you have the right to obtain, upon
request and free of charge, a copy of internal rules or
guidelines relied upon in making this determination
• If your denial is based on medical necessity or similar
limitations, an explanation of this rule (or a statement that
it is available upon request), and
• Notice regarding your right to bring a court action
following a denial on appeal.
You also will receive a notice if the claim on appeal
is approved.
APPEALING AN ACCIDENT CLAIM THAT HAS
BEEN FULLY OR PARTIALLY DENIED
You may appeal any denial of a claim for benefits by filing
a written request with Allstate Benefits. In connection with
an appeal, you may request, free of charge, all documents
that are relevant (as defined by ERISA) to your claim.
You may also submit with your appeal any comments,
documents, records, and issues that you believe support
your claim, even if you have not previously submitted such
documentation. You may have representation throughout
the review procedure.
An appeal must be filed with Allstate Benefits in accordance
with the claim filing procedures described in your denial
letter within 60 days of receipt of the written notice of
denial of a claim. Allstate Benefits will render a decision
no later than 60 days after receipt of your written appeal.
In special circumstances, an extension of time may be
necessary to make a decision. In that case, Allstate Benefits
may take a 60‑day extension. The decision after your appeal
will be in writing and will include:
• A statement that you have the right to obtain, upon
request and free of charge, a copy of internal rules or
guidelines relied upon in making this determination
• If your denial is based on medical necessity or similar
limitations, an explanation of this rule (or a statement that
is available upon request)
• A description of any voluntary review procedures offered
by the Plan and your right to obtain information about such
procedures, and
• A statement regarding your right to bring court action
following a denial on appeal.
You also will receive a notice if the claim on appeal is
approved. If your claim is denied, you have the right to
bring action in federal court in accordance with ERISA
Section 502(a), but only after you have followed the Plan’s
claims and appeals procedures.
See Deadlines to file a claim or bring legal action earlier in
this chapter regarding the deadlines to bring legal action.
Company-paid life insurance,
optional associate and dependent
life insurance, business travel
accident insurance, and AD&D
claims process
Claims for company‑paid life, optional associate
and dependent life, business travel accident, and
AD&D insurance can be initiated by calling Prudential
at 877-740-2116.
See the applicable insurance chapter for details on the
information required to file each type of claim. When you
submit a claim to Prudential and your claim is denied, a
notice will be sent within a reasonable time period, but not
longer than 90 days from receipt of the claim. If Prudential
determines that an extension is necessary due to matters
beyond Prudential’s control, this time may be extended for
an additional 90‑day period. You will receive notice prior
to the extension that indicates the circumstances requiring
the extension and the date by which Prudential expects to
render a determination.
• The specific reasons for the denial
• Reference to provisions of the Plan on which the denial
If your claim is in part or wholly denied, you will receive
notice of an adverse benefit determination that will:
was based
• A statement that you have the right to receive, upon
request and free of charge, reasonable access to, and
copies of, all documents, records, and other information
relevant to the claim for benefits
• State the specific reasons for the adverse benefit
determination
• Reference the specific plan provisions on which the
determination is based
• Describe additional material or information, if any, needed
to perfect the claim and the reasons such material or
information is necessary, and
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• Describe Prudential’s claims review procedures and
the time limits applicable to such procedures, including
a statement of your right to bring a civil action under
Section 502(a) of ERISA following an adverse benefit
determination on review.
APPEALING A PRUDENTIAL CLAIM THAT HAS
BEEN FULLY OR PARTIALLY DENIED
If your claim for benefits is denied and you would like to
appeal, you must send a written appeal to Prudential at the
address below within 180 days of the denial. Your appeal
should include any comments, documents, records, or any
other information you would like considered.
Send your written appeal to:
Prudential Insurance Company of America
Prudential Group Life Claim Division
P.O. Box 8517
Philadelphia, Pennsylvania 19176
You will have the right to request copies, free of charge, of
all documents, records, or other information relevant to your
claim. Your appeal will be reviewed without regard to your
initial determination by someone other than the party who
decided your initial claim. Prudential will make a determination
on your appeal within 45 days of the receipt of your appeal
request. This period may be extended by up to an additional
45 days if Prudential determines that special circumstances
require an extension of time. You will be notified prior to the
end of the 45‑day period if an extension is required. If you are
asked to provide additional information, you will have 45 days
from the date you are notified to provide the information, and
the time to make a determination will be suspended until you
provide the requested information (or the deadline to provide
the information, if earlier).
If your appeal is denied in whole or in part, you will receive
a written notification from Prudential of the denial that
will include:
• The specific reasons for the adverse determination
• Reference to the specific plan provisions on which the
determination was based
• A statement describing your right to request copies, free
of charge, of all documents, records, or other information
relevant to your claim
• A description of Prudential’s review procedures and
applicable time limits
• A statement that you have the right to obtain, upon
request and free of charge, a copy of internal rules or
guidelines relied upon in making this determination, and
• A statement describing any appeals procedures offered by
the Plan and your right to bring a civil suit under ERISA.
If a decision on appeal is not furnished to you within the
time frames mentioned earlier, the claim shall be deemed
denied on appeal.
VOLUNTARY SECOND APPEAL OF LIFE
INSURANCE, AD&D, OR BUSINESS TRAVEL
ACCIDENT CLAIMS
If your appeal is denied or if you do not receive a response
to your appeal within the appropriate time frame (in which
case the appeal is deemed to have been denied), you or
your representative may make a voluntary second appeal
of your denial in writing to Prudential. You must submit your
second appeal within 180 days of the receipt of the written
notice of denial or 180 days from the date such claim is
deemed denied. You may submit any written comments,
documents, records, and any other information relating
to your claim. The same criteria and response times that
applied to your first appeal are generally applied to this
voluntary second appeal.
See Deadlines to file a claim or bring legal action earlier in
this chapter regarding the deadline to bring legal action.
Claims and appeals process for
disability coverage claims
NOTE: This section describes the claims and appeals
process for the short‑term disability plan for full‑time
hourly associates (basic and enhanced), the long‑term
disability plan, and the truck driver long‑term disability
plan. For claims and appeals information for the short‑term
disability plans for salaried associates and truck drivers,
refer to the respective chapters.
FILING A CLAIM
All requests of leaves of absence are administered by
Sedgwick. Notify Sedgwick to apply for a leave of absence
and file a short‑term disability claim as soon as you know
you will be absent from work due to an illness, injury, or
pregnancy. You may do this by visiting One.Walmart.com
> mySedgwick, or by calling 800-492-5678. You may also
submit claims by mail to:
Sedgwick Claims Management Services, Inc.
P.O. Box 14748
Lexington, Kentucky 40512-4748
For associates in states or localities with legally mandated
benefits, you should submit your claim directly to the state
or local government. If you are appealing a Sedgwick‑
managed claim, file your appeal with Sedgwick, as described
above. For information, including filing timelines, call
the appropriate phone number listed in the Resources
chart at the beginning of the Full-time hourly short-term
disability chapter.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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Claims under the long‑term disability and truck driver long‑
term disability plans should be submitted to:
• A discussion of the decision, including an explanation of
the basis for disagreeing with or not following:
Group Benefits Claims
Lincoln Financial Group
Group — Charlotte WM
P.O. Box 2578
Omaha, Nebraska 68172-9688
FILING DEADLINES
Claims for short‑term disability benefits in Hawaii, New
Jersey, and New York must be submitted to Sedgwick within
30 days of the date your disability begins. Sedgwick will
notify Lincoln of your disability claim.
For all other states (with the exception of California and
Rhode Island, as noted above), you must submit your short‑
term disability claim to Sedgwick within 90 days of the date
your disability begins in order to assure consideration for
benefits. Claims filed later than 90 days after the date of
disability may be denied unless Sedgwick determines you
had good cause for filing late.
If you are on an approved short‑term disability claim and
are enrolled in long‑term disability (LTD) or truck driver
LTD, your claim will automatically be transitioned to Lincoln
for consideration.
If you work in Connecticut, Massachusetts, Washington,
D.C., or Washington State, you should promptly apply to
Sedgwick and to your state or locality for state‑mandated
benefits. Note that associates in Washington, D.C. will
generally not receive benefits for periods prior to the
date of the application for benefits, except in emergency
situations.
Once a claim has been filed, a decision will be made in no
more than 45 days after receipt of your properly filed
claim. The time for decision may be extended for up to
two additional 30‑day periods, provided that, prior to
any extension period, you are notified in writing that an
extension is necessary due to matters beyond control, those
matters are identified, and you are given the date by which
a decision will be rendered. If your claim is extended due
to your failure to submit information necessary to decide
your claim, the time for decision may be tolled from the
date on which the notification of the extension is sent to
you until the date your response is received. If your claim is
approved, the decision will contain information sufficient to
reasonably inform you of that decision.
Any adverse benefit determination will be in writing and
will include:
• Specific reasons for the decision
• Specific reference to the Plan provisions on which the
decision is based
– The views presented by you to the Plan of health care
professionals treating you and vocational professionals
evaluated by you
– The views of medical or vocational experts whose
advice was obtained on behalf of the Plan in connection
with your adverse benefit determination, regardless
of whether the advice was relied upon in making the
benefit determination, and
– A disability determination regarding you made by the
Social Security Administration and presented by you to
the Plan.
• Either the specific internal rules, guidelines, protocols,
standards, or other similar criteria of the Plan relied upon
in making the adverse determination or, alternatively, a
statement that such rules, guidelines, protocols, standards,
or other similar criteria of the Plan do not exist
• If the adverse benefit determination is based on a medical
necessity or experimental treatment or similar exclusion
or limit, either an explanation of the scientific or clinical
judgment for the determination, applying the terms of
the Plan to your medical circumstances, or a statement
that such explanation will be provided free of charge
upon request
• A description of any additional material or information
necessary for you to perfect the claim and an explanation
of why such material or information is necessary
• A statement that you are entitled to receive, upon request
and free of charge, reasonable access to, and copies of,
all documents, records, and other information relevant to
your claim for benefits
• A description of the review procedures and time limits
applicable to such procedures, and
• A statement that you have the right to bring a civil action
under Section 502(a) of ERISA after you appeal the
decision if you receive a written denial on appeal.
APPEALING A DISABILITY CLAIM THAT HAS
BEEN FULLY OR PARTIALLY DENIED
If your claim for disability benefits is denied and you
would like to appeal, you must submit a written or oral
appeal to Sedgwick or Lincoln (as applicable) within 180 days
of the denial.
For associates in states or localities with legally mandated
plans, such as California, Connecticut, Massachusetts,
Rhode Island, Washington State, and Washington, D.C.,
you should submit your appeal directly to the state or local
government. For information, including filing timelines,
call the appropriate phone number listed in the Resources
chart at the beginning of the Full-time hourly short-term
disability chapter.
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Your appeal will be conducted without regard to your
initial determination by someone other than the party
who decided your initial claim or a subordinate of the
individual who decided your initial claim. No deference will
be afforded to the initial determination. You will have the
opportunity to submit written comments, documents, or
other information in support of your appeal. You have the
right to request copies, free of charge, of all documents,
records, or other information relevant to your claim. The
third‑party administrator, on behalf of the Plan, will provide
you with any new or additional evidence or rationale
considered in connection with your claim sufficiently in
advance of the appeals determination date to give you a
reasonable opportunity to respond.
If your claim involves a medical judgment question, the
Plan will consult with an appropriately qualified health
care practitioner with training and experience in the field
of medicine involved. If a health care professional was
consulted for the initial determination, a different health
care professional will be consulted on appeal. Upon request,
the Plan will provide you with the identification of any
medical expert whose advice was obtained on behalf of the
Plan in connection with your appeal.
Sedgwick or Lincoln (as applicable) will make a determination
on your appeal within 45 days of the receipt of your appeal
request. This period may be extended by up to an additional
45 days if it is determined that special circumstances require
an extension of time. You will be notified prior to the end of
the 45‑day period if an extension is required. If you are asked
to provide additional information, you will have 45 days from
the date you are notified to provide the information, and
the time to make a determination will be suspended until
you provide the requested information (or the deadline to
provide the information, if earlier).
If your appeal is denied in whole or in part, you will receive a
written notification of the denial that will include:
• The specific reasons for the adverse determination
• Reference to the specific Plan provisions on which the
determination was based
• A discussion of the decision, including an explanation of
the basis for disagreeing with or not following:
– The views presented by you to the Plan of health care
professionals treating you and vocational professionals
who evaluated you
– The views of medical or vocational experts whose
advice was obtained on behalf of the Plan in connection
with your adverse benefit determination, regardless
of whether the advice was relied upon in making the
benefit determination, and
– A disability determination regarding you made by the
Social Security Administration and presented by you to
the Plan.
• Either the specific internal rules, guidelines, protocols,
standards, or other similar criteria of the Plan relied upon
in making the adverse determination or, alternatively, a
statement that such rules, guidelines, protocols, standards,
or other similar criteria of the Plan do not exist
• If the adverse benefit determination is based on a medical
necessity or experimental treatment or similar exclusion
or limit, either an explanation of the scientific or clinical
judgment for the determination, applying the terms of
the Plan to your medical circumstances, or a statement
that such explanation will be provided free of charge
upon request
• A statement that you are entitled to receive, upon request
and free of charge, reasonable access to, and copies of,
all documents, records, and other information relevant to
your claim for benefits, and
• A statement that you have the right to bring a civil action
under Section 502(a) of ERISA (including a description of
any contractual limitation period that applies and the date
on which the contractual limitation period expires).
See Deadlines to file a claim or bring legal action earlier
in this chapter regarding the deadline to bring legal
action. See Appealing an enrollment or eligibility status
decision earlier in this chapter for information on appealing
eligibility determinations.
All other appeals under the short‑term disability plan for
full‑time hourly associates for all states except California,
Hawaii, New Jersey, New York, and Rhode Island should be
submitted to:
Walmart Disability and Leave Service Center at Sedgwick
National Appeals Unit
P.O. Box 14748
Lexington, Kentucky 40512-4748
For associates in states with legally mandated benefits,
you should submit your appeal directly to the state or local
government. If you are appealing your Sedgwick‑managed
claim, file your appeal with Sedgwick as described above.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
For salaried associates and truck drivers, see the Salaried
short-term disability plan chapter or the Truck driver
short-term disability plan chapter, as appropriate,
for detailed information on the appeals process for
those plans.
Appeals for short‑term disability benefits in Hawaii, New
Jersey, and New York, and long‑term disability appeals,
should be sent to:
Group Benefits Claims Appeal Unit
Lincoln Financial Group
Group — Charlotte WM
Attn: Appeal Review Unit
P.O. Box 2578
Omaha, Nebraska 68172-9688
VOLUNTARY SECOND APPEAL OF A CLAIM
FOR BENEFITS UNDER THE FULL-TIME HOURLY
SHORT-TERM DISABILITY PLAN
If you are a full‑time hourly associate whose short‑term
disability coverage is administered through Sedgwick and
your appeal is denied, you may make a voluntary second
appeal of your denial orally or in writing to Sedgwick. You
must submit your second appeal within 180 days of the
receipt of the written notice of denial. You may submit
any written comments, documents, records, and any
other information relating to your claim. The same criteria
and response times that applied to your first appeal, as
described earlier, are generally applied to this voluntary
second appeal.
Voluntary second appeals for short‑term disability benefits
should be sent to:
Walmart Disability and Leave Service Center at Sedgwick
National Appeals Unit
P.O. Box 14748
Lexington, Kentucky 40512-4748
See Deadlines to file a claim or bring legal action earlier
in this chapter regarding the deadlines to bring legal action.
Resources for Living benefits
You do not have to file a claim or appeal for Resources
for Living benefits. You may access the Resources for
Living website or call Resources for Living at 800-825-3555
at any time.
However, if you have a question about your benefits, or
disagree with the benefits provided, you may contact
People Services or file a claim or appeal by writing to the
following address:
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Walmart Total Rewards Benefits
Attn: Internal Appeals
508 SW 8th Street
Bentonville, Arkansas 72716-3500
Any claims or appeals will be determined under the time
frames and requirements applicable to medical benefits.
International business travel
medical insurance
Claim forms are generally not required for GeoBlue
services. However, if you have a question about your
benefits or disagree with the benefits provided, you may
contact GeoBlue or file a claim. To submit a claim via email
or fax, download a claim form and view detailed instructions
in the Member Hub at geo-blue.com. Submit your claim by
email to claims@geo-blue.com or by fax to 610-482-9623.
You may also submit claims by post. Download a claim form
from the Member Hub at geo‑blue.com and send your
completed form to:
GeoBlue
Claims Department
P.O. Box 1748
Southeastern, Pennsylvania 19399-1748
Any claims and appeals will be determined under the time
frames and requirements set out in the GeoBlue policy.
Contact GeoBlue at any time by calling 888-412-6403.
Outside the U.S. call collect: 610-254-5830.
Legal information
Associates’ Health and Welfare Plan
Plan identifying information
Plan funding
Plan amendment or termination
Your rights under ERISA
HIPAA notice of privacy practices
Medicare and your prescription drug coverage
Premium assistance under Medicaid and the Children’s Health Insurance Program (CHIP)
Valued Plan Participant
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2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Legal information
The 2022 Associate Benefits Book contains separate chapters that taken together constitute
the Summary Plan Description (SPD) for the Walmart Inc. Associates’ Health and Welfare
Plan (the Plan). Specifically, the SPD for the Plan includes the following chapters:
• Eligibility and enrollment
• Company‑paid life insurance
• Eligibility and benefits for associates in Hawaii
• Optional associate life insurance
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• The medical plan
• The pharmacy benefit
• The dental plan
• The vision plan
• COBRA
• Resources for Living
• Critical illness insurance
• Accident insurance
• Optional dependent life insurance
• Accidental death and dismemberment (AD&D) insurance
• Business travel accident insurance
• Short‑term disability for full‑time hourly associates
• Long‑term disability
• Truck driver long‑term disability
• Claims and appeals
In this Legal information chapter of the SPD, you will find important administrative information and
facts about your rights as a participant in the Plan.
RESOURCES
Find What You Need
Online
Other Resources
Contact the Plan Administrator
Answers to questions about the
HIPAA Privacy Notice
Email your question to
AHWPrivacy@walmart.com
Visit medicare.gov
Answers to questions about
Medicare Part D
Answers to your questions
about Medicaid/CHIP
Write to:
Plan Administrator
Senior Vice President, U.S. Benefits
Associates’ Health and Welfare Plan
508 SW 8th Street
Bentonville, Arkansas 72716-3500
Call 479-621-2058
Call People Services at
800-421-1362
800-MEDICARE (800-633-4227)
TTY users should call 877-486-2048
Visit insurekidsnow.gov
877-KIDSNOW (877-543-7669)
What you need to know about the legal information for
the Associates’ Health and Welfare Plan
• As a participant in the Plan, you are entitled to certain rights and protections under the Employee Retirement Income
Security Act of 1974 (ERISA), as amended.
• The HIPAA privacy notice in this chapter describes how medical information about you may be used and disclosed and
how you can get access to this information.
• The Medicare and your prescription drug coverage section in this chapter explains the options you have under
Medicare prescription drug coverage and can help you decide whether or not you want to enroll.
• The Medicaid/Children’s Health Insurance Program (CHIP) notice explains special enrollment and premium assistance
rights for individuals eligible for these programs.
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Associates’ Health and Welfare Plan
Walmart Inc. maintains the Plan for the exclusive benefit
of its eligible associates and their eligible family members.
The Plan provides health and welfare benefits through the
following component benefit programs:
• Self‑funded medical benefits, including pharmacy*
• Medical insurance (including HMOs)**
• Self‑funded dental benefits
• Vision insurance
• Resources for Living
• Critical illness insurance
• Accident insurance
• Company‑paid life insurance
• Optional associate life insurance
• Optional dependent life insurance
• Accidental death and dismemberment insurance
• Business travel accident insurance
• Self‑funded short‑term disability benefits
• Long‑term disability insurance
Each component benefit program (except for medical
insurance) is summarized in the respective chapter of this
SPD. Medical insurance (including HMOs) is summarized
in a certificate of insurance booklet issued by an insurance
company, a summary prepared specifically for that
component benefit program. These summaries are also part
of the Plan’s SPD.
The terms and conditions of the Plan are set forth in this
SPD, in the Associates’ Health and Welfare Plan Wrap
Document (Wrap Document), and in the insurance policies
and other welfare program documents incorporated
into the Wrap Document. The Wrap Document, together
with this book and the other incorporated documents,
constitutes the written instrument under which the
Plan is established and maintained. An amendment to an
incorporated document, including this SPD, is considered an
amendment to the Plan.
* Self‑funded medical benefits include the following plan options:
Premier Plan, Contribution Plan, Saver Plan, and Local Plans.
** Medical insurance includes the following plan options:
PPO Plan, HMOs.
Plan identifying information
Plan Sponsor:
Walmart Inc.
702 SW 8th Street
Bentonville, Arkansas 72716-0295
Plan Sponsor’s EIN: 71-0415188
Plan Number: 501
Type of Plan: Welfare, including medical, dental, vision,
associate assistance program, critical illness insurance,
accident insurance, company‑paid life insurance, optional
associate and dependent life insurance, accidental death and
dismemberment (AD&D), business travel accident insurance,
short‑term disability, and long‑term disability insurance.
Type of Administration: The Plan is administered by the
Plan Administrator. The Plan Administrator has delegated
fiduciary responsibility for determinations of claims
for benefits and appeals under the self‑funded benefit
components to third‑party administrators. For insured
benefit components, insurers have fiduciary responsibility
for determinations of claims for benefits and appeals.
Each chapter in this SPD identifies the specific third party,
including insurers that administer claims and appeals for the
respective benefits.
The Plan Administrator (or its delegates, including third‑party
administrators and insurers deciding claims and appeals) has
complete discretion to interpret and construe the provisions
of the Plan, make findings of fact, correct errors, and supply
omissions. All decisions and interpretations of the Plan
Administrator (or a delegate) made pursuant to the Plan shall
be final, conclusive and binding on all persons, and may not
be overturned unless found by a court to be arbitrary and
capricious. Benefits will be paid only if the Plan Administrator
(or a delegate) determines in its sole discretion that the
claimant is entitled to them.
Plan Administrator and Named Fiduciary:
Senior Vice President, U.S. Benefits
Walmart Inc. Associates’ Health and Welfare Plan
508 SW 8th Street
Bentonville, Arkansas 72716-3500
479-621-2058
Named Fiduciary (for self-funded medical, pharmacy,
dental, and short-term disability benefits): For each of the
self‑funded component benefit programs, the applicable
third‑party administrator is a named fiduciary with respect
to decisions regarding whether a claim for benefits will be
paid under the Plan.
Named Fiduciary (for vision, critical illness, accident,
company-paid life, optional associate life, optional
dependent life, AD&D, business travel accident, long-term
disability, and medical insurance): For each of the insured
component benefit programs, the applicable insurance
company is a named fiduciary with respect to decisions
regarding whether a claim for benefits will be paid under
the insurance contract.
Plan Trustee:
J. P. Morgan
4 New York Plaza, 15th Floor
New York, New York 10004-2413
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Agent for Service of Legal Process:
Corporation Trust Company
1209 Orange Street Corporation Trust Center
Wilmington, Delaware 19801
Legal process may also be served on the Plan Administrator
or Trustee.
Plan Year: January 1 through December 31
Plan funding
Walmart Inc. may fund Plan benefits out of its general assets
or through contributions made to the Walmart Inc. Associates’
Health and Welfare Trust. Contributions also may be required
by employees, in an amount determined by Walmart Inc. in
its sole discretion. All assets of the Plan, including associate
contributions and any dividends or earnings of the Plan, shall
be available to pay any benefits provided under the Plan or
expenses of the Plan, including insurance premiums.
Plan amendment or termination
Walmart reserves the right within its sole discretion to
amend or terminate any benefit or provision under the Plan,
at any time and for any reason, as it relates to any current,
past, or future participant or beneficiary under the Plan.
Neither the Plan nor the benefits described in this book can
be orally amended. All oral statements and representations
shall be without force or effect, even if such statements
and representations are made by the Plan Administrator,
a management associate of the company, a representative
in the benefits call center, or a third‑party administrator.
Only written statements by the Plan Administrator shall
bind the Plan.
Your rights under ERISA
As a participant in the Plan, you are entitled to certain rights
and protections under the Employee Retirement Income
Security Act of 1974 (ERISA), as amended. ERISA provides
that all Plan participants shall be entitled to:
RECEIVE INFORMATION ABOUT YOUR PLAN
AND BENEFITS
You have the right to:
• Examine, without charge, at the Plan Administrator’s office
and at other specified facilities, such as worksites and
union halls, all documents governing the Plan, including
insurance contracts and collective bargaining agreements,
and a copy of the latest annual report (Form 5500 Series)
filed by the Plan with the U.S. Department of Labor and
available at the Public Disclosure Room of the Employee
Benefits Security Administration.
• Obtain, upon written request to the Plan Administrator,
copies of documents governing the operation of the
Plan, including insurance contracts and collective
bargaining agreements, and copies of the latest annual
report (Form 5500 Series) and updated Summary Plan
Description. The Administrator may make a reasonable
charge for the copies.
• Receive a summary of the Plan’s annual financial report.
The Plan Administrator is required by law to furnish each
participant with a copy of this annual report.
CONTINUE GROUP HEALTH PLAN COVERAGE
You have the right to continue health care coverage for
yourself, your spouse, or your dependents if there is a loss
of coverage under the Plan as a result of a qualifying event.
You or your dependents may have to pay for such coverage.
Review this SPD and the documents governing the Plan on
the rules governing your COBRA continuation coverage
rights. (See the COBRA chapter for more information.)
You should be provided a certificate of creditable coverage,
free of charge, from the Plan or health insurance issuer
when you lose coverage under the Plan, when you become
entitled to elect COBRA continuation coverage, or when
your COBRA continuation coverage ceases, if you request it
before losing coverage or if you request it up to 24 months
after losing coverage.
The Plan’s medical benefit component does not have a
pre‑existing condition exclusion.
PRUDENT ACTIONS BY PLAN FIDUCIARIES
In addition to creating rights for Plan participants, ERISA
imposes duties upon the people who are responsible for
the operation of the Plan. The people who operate the
Plan, called “fiduciaries” of the Plan, have a duty to do
so prudently and in the interest of you and other Plan
participants and beneficiaries. No one, including your
employer, your union, or any other person, can fire you or
otherwise discriminate against you in any way to prevent
you from obtaining benefits or exercising your rights
under ERISA.
If your claim for a benefit is denied or ignored, in whole
or in part, you have the right to know why this was done,
to obtain copies of documents relating to the decision
without charge, and to appeal any denial, all within certain
time schedules.
Under ERISA, there are steps you can take to enforce the
above rights. For instance:
• If you request materials from the Plan and do not
receive them within 30 days, you can file suit in a federal
court. In such a case, the court may require the Plan
Administrator to provide the materials and pay you up
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to $110 a day until you receive the materials, unless the
materials were not sent because of reasons beyond the
control of the Administrator.
• If you have a claim for benefits that is denied or ignored, in
whole or in part, you can file suit in a state or federal court.
Generally, you must complete the appeals process before
filing a lawsuit against the Plan. However, you should
consult with your own legal counsel in determining when it
is proper to file a lawsuit against the Plan.
• If you disagree with the Plan’s decision or lack thereof
concerning the qualified status of a domestic relations
order or a medical child support order, you can file suit in a
federal court.
• If it should happen that Plan fiduciaries misuse the Plan’s
money, or if you are discriminated against for asserting
your rights, you can seek assistance from the U.S.
Department of Labor, or you can file suit in a federal court.
The court will decide who should pay court costs and
legal fees. If you are successful, the court may order the
person you have sued to pay these costs and fees. If you
lose, the court may order you to pay these costs and fees;
for example, if it finds your claim is frivolous.
ASSISTANCE WITH YOUR QUESTIONS
If you have any questions about the Plan, you should contact
the Plan Administrator. If you have any questions about
this statement or about your rights under ERISA, or if you
need assistance in obtaining documents from the Plan
Administrator, you should contact the nearest office of the
Employee Benefits Security Administration, U.S. Department
of Labor, listed in your telephone directory or the:
Division of Technical Assistance and Inquiries
Employee Benefits Security Administration
U. S. Department of Labor
200 Constitution Avenue NW
Washington, DC 20210
You can also obtain certain publications about your rights
under ERISA by calling the Employee Benefits Security
Administration publications hotline at 866-444-3272 or by
going to dol.gov/ebsa.
HIPAA notice of privacy practices
This notice was updated August 1, 2019
THIS NOTICE APPLIES TO THE ASSOCIATES’ MEDICAL
PLAN (AMP), DENTAL PLAN, AND RESOURCES FOR LIVING
(RFL), REFERRED TO COLLECTIVELY AS THE “PLANS”
THE PLANS’ COMMITMENT TO YOUR PRIVACY
business travel medical plan. For these benefit options, the
insurer of the HMO or PPO Plan or international business
travel medical plan is responsible to protect your health
information under the HIPAA rules, including providing you
with its own notice of privacy practices.
The Plans are dedicated to maintaining the privacy of your
health information for as long as the Plans hold your health
information or for fifty years after your death. In operating
the Plans, we create records regarding you and the benefits
we provide to you. This notice will tell you about the ways
in which we may use and disclose health information about
you. We will also describe your rights and certain obligations
we have regarding the use and disclosure of health
information. We are required by law to:
• Maintain the privacy of your health information, also
known as Protected Health Information (PHI)
• Provide you with this notice
• Comply with this notice, and
• Notify you if there is a breach of your unsecured PHI.
The Plans reserve the right to change our privacy practices
and to make any such change applicable to the PHI we
obtained about you before the change. If there is a material
revision to this notice, the new notice will be distributed to
you. You may obtain a paper copy of the current notice by
contacting the Plans using the contact information listed
at the end of this notice. The most current notice is also
available on One.Walmart.com.
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY. You have certain rights
under the Health Insurance Portability and
Accountability Act (HIPAA). HIPAA governs
when and how your medical health information
held by the AMP, dental plan, and RFL may be
used and disclosed and how you can get access
to this information. Please share a copy of
this notice with your family members who are
covered under the AMP, dental plan, and RFL.
HOW THE AMP, DENTAL PLAN, AND RFL MAY
USE AND DISCLOSE YOUR PHI
The law permits us to use and disclose your protected
health information (PHI) for certain purposes without your
permission or authorization. The following gives examples of
each of these circumstances:
References to “we” and “us” throughout this notice mean the
Plans. Walmart also provides benefits for some associates
through a Health Maintenance Organization (HMO), a
fully insured PPO Plan and a fully insured international
1. For Treatment. We may use or disclose your PHI for
purposes of treatment. For example, we may disclose
your PHI to physicians, nurses, and other professionals
who are involved in your care.
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2. For Payment. We may use or disclose your PHI to provide
payment for the treatment you receive under the Plans.
For example, we may contact your health care provider
to certify that you have received treatment (and for what
range of benefits), and we may request details regarding
your treatment to determine if your benefits will cover,
or pay for, your treatment. We also may use and disclose
your PHI to obtain payment from third parties that may
be responsible for such costs, such as family members or
other insurance companies.
3. For Health Care Operations. We may use or disclose
your PHI for our health care operations. For example,
our claims administrators in some states or the Plans may
use your PHI to conduct cost‑management and planning
activities. Any information which we use or disclose for
underwriting purposes will not include any of your PHI
which is genetic information.
4. To the Plans’ Sponsor. The Plans may use or disclose your
PHI to Walmart, the Plan Sponsor. The Plans’ Sponsor
will only use your PHI as necessary to administer the
Plans. The law only permits the Plans to disclose your PHI
to Walmart, in its role as the Plans’ Sponsor, if Walmart
certifies, among other things, that it will only use or
disclose your PHI as permitted by the Plan, will restrict
access to your PHI to those Walmart employees whose
job it is to administer the Plan, and will not use PHI for
any employment‑related actions.
5. For Health-Related Programs and Services. The Plans
may contact you about information regarding treatment
alternatives or other health‑related benefits and services
that may be of interest to you.
6. To Individuals Involved in Your Care or Payment for Your
Care. The Plans may disclose your PHI to a third party
involved in your health care including a family member,
close friend, or a person you identified to the Plan as
involved in your health care, provided that you agree to this
disclosure. If you are not present or available to agree or
disagree to disclose your PHI to a third person requesting
the PHI, then the Plans may use professional judgment to
determine if the disclosure of PHI is in your best interests.
If it is determined that a disclosure of PHI is then in your
best interest, the Plans may disclose the minimum amount
of PHI necessary to meet the need. Additionally, you have
the right to request that the Plans limit any disclosure of
PHI to specific individuals involved in your health care.
OTHER USES OR DISCLOSURES OF YOUR PHI
WITHOUT AN AUTHORIZATION
The law allows us to disclose your PHI in the following
circumstances without your permission or authorization:
1. When Required by Law. The Plans will use and disclose
your PHI when we are required to do so by federal, state,
or local law.
2. For Public Health Risks. The Plans may disclose your
PHI for public health activities, such as those aimed at
preventing or controlling disease, preventing injury,
reporting reactions to medications or problems with
products, and reporting the abuse or neglect of children,
elders, and dependent adults.
3. For Health Oversight Activities. The Plans may disclose
your PHI to a health oversight agency for activities
authorized by law. These oversight activities, which are
necessary for the government to monitor the health
care system, include investigations, inspections, audits,
and licensure.
4. For Lawsuits and Disputes. The Plans may use or disclose
your PHI in response to a court or administrative order
if you are involved in a lawsuit or similar proceeding. We
also may disclose your PHI in response to a discovery
request, subpoena, or other lawful process by another
party involved in the dispute, but only if we receive
satisfactory assurances from the party seeking the
information that reasonable efforts have been made to
inform you of the request and given you the opportunity
to raise an objection to the court or obtain an order
protecting the information the party has requested.
5. To Law Enforcement. The Plans may release your PHI if
asked to do so by a law enforcement official in certain
circumstances, including but not limited to the following:
– Regarding a crime victim in certain situations, if we
are unable to obtain the person’s agreement
– Concerning a death we believe might have resulted
from criminal conduct
– Regarding criminal conduct at our offices
– In response to a warrant, summons, court order,
subpoena, or similar legal process
– To identify/locate a suspect, material witness, fugitive,
or missing person
– In an emergency, to report a crime (including the
location or victim(s) of the crime or the description,
identity, or location of the person who committed the
crime), and
– In cases where a law enforcement agency has
requested PHI for purposes of identifying or locating
an individual, HIPAA permits that if certain specific
situations are met, the Plans must disclose to the
law enforcement agency limited information such as
name, address, Social Security number, ABO blood
type, type of injury, date and time of treatment or
death, and distinguishing physical characteristics.
6. To Avert a Serious Threat to Health or Safety. The Plans
may use or disclose your PHI when necessary to reduce
or prevent a serious threat to your health and safety or
the health and safety of another individual or the public.
Under these circumstances, we will only make disclosures
to a person or organization able to help prevent the threat.
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7. For Military Functions. The Plans may use or disclose
your PHI if you are a member of the U.S. or foreign
military forces (including veterans), and if required to
assure the proper execution of a military mission if the
appropriate military authority has published the required
information in the Federal Register.
8. For National Security. The Plans may disclose your PHI
to federal officials for intelligence and national security
activities authorized by law. We also may disclose
your PHI to federal officials in order to protect the
president, other officials or foreign heads of state or to
conduct investigations.
9. Inmates. The Plans may disclose your health information
to correctional institutions or law enforcement officials
if you are an inmate or under the custody of a law
enforcement official. Disclosure for these purposes
would be necessary: for the institution to provide health
care services to you; for the safety and security of the
institution; and/or to protect your health and safety or
the health and safety of other individuals.
10. To Workers’ Compensation Programs. The Plans
may release your health information for workers’
compensation and similar programs.
11. For Services Related to Death. The Plans may disclose
your PHI upon your death to a coroner, funeral director,
or to tissue or organ donation services, as necessary to
permit them to perform their functions.
12. Research. HIPAA permits the Plans to disclose PHI for
government‑approved research purposes. It is the policy
of the Plans not to disclose PHI for research purposes
and will not disclose your PHI for such purposes unless
the PHI is required to be disclosed under law.
13. Psychotherapy Notes. An authorization is always required
to use or disclose psychotherapy notes to a third person
unless the use or disclosure is permitted under HIPAA
regulations. Permissible uses or disclosures include: use
for treatment, payment, or health care operations; use
by the originator of the notes for treatment; use by the
Plans to defend themselves in a lawsuit that you initiate;
when required by the Secretary of the Department
of Health and Human Services; when such disclosure
is required by law; for health oversight activities as
permitted under the regulations; disclosure to a person
who can reasonably prevent serious harm to an individual
or the public; and disclosure to a medical examiner
or coroner for the purpose of identifying a deceased
person, determining cause of death, or such other
purposes permitted by law. While the regulations permit
covered entities to use and disclose psychotherapy notes
for purposes of training health professionals or students,
the Plans do not engage in such training exercises and
cannot disclose the information for these purposes.
14. Victims of Abuse, Neglect, or Domestic Violence. The
Plans may disclose your PHI if there is reasonable belief
that you are a victim of abuse, neglect, or domestic
violence. Such disclosure is permitted under HIPAA only
if required by law or with your permission or to the extent
the disclosure is expressly authorized by statute and only if,
in the Plan’s best judgment, the disclosure is necessary to
prevent serious harm to you or other potential victims.
15. Health Oversight Activities and Joint Investigations. The
Plans must disclose PHI requested of health oversight
agencies for purposes of legally authorized audits,
investigations including joint investigations, inspections,
licensure, disciplinary actions, or other oversight activities
of authorized entities.
16. Disaster Relief Efforts. The Plans may use or disclose your
PHI to notify a family member or other individual involved
in your care of your location, general condition or death, or
to a public or private entity authorized by law or its charter
to assist in disaster relief efforts to make such notification.
USES AND DISCLOSURES REQUIRING
YOUR AUTHORIZATION
The Plans will obtain your written authorization for any
other uses or disclosures of your PHI, including for most
uses and disclosures of psychotherapy notes (except in
situations noted above), uses and disclosures of PHI for
marketing purposes, and uses or disclosures that are a
sale of PHI. The Plan will not condition your eligibility to
participate in the Plan or payment of benefits under the
Plan upon your authorization, except where allowed by law.
If you give us written authorization for a use or disclosure of
your PHI, you may revoke that authorization at any time in
writing. If you revoke your authorization, we will no longer
use or disclose your PHI for the reasons described in the
authorization, except for where we have taken action in
reliance on your authorization before we received your
written revocation.
STRICTER STATE PRIVACY LAWS
Under the HIPAA Privacy Regulations, the Plan is required
to comply with state laws, if any, that also are applicable
and are not contrary to HIPAA (for example, where state
laws may be stricter). The Plan maintains a policy to ensure
compliance with these laws.
YOUR RIGHTS RELATED TO YOUR PHI
You have the following rights regarding your PHI that
we maintain:
1. Right to Request Confidential Communications. You
have the right to request that the Plans communicate
with you about your health and related issues in a
particular manner or at a certain location if you feel
that your life may be endangered if communications
are sent to your home. For example, you may ask that
we contact you at work rather than home. In order to
request a type of confidential communication, you must
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make a written request to the address at the end of this
section specifying the requested method of contact
or the location where you wish to be contacted. For
us to consider granting your request for a confidential
communication, your written request must clearly state
that your life could be endangered by the disclosure of
all or part of this information.
2. Right to Request Restrictions. You have the right to
request a restriction in our use or disclosure of your
PHI for treatment, payment, or health care operations.
We generally are not required to agree to your request
except in limited circumstances; however, if we do
agree, we are bound by our agreement except when
otherwise required by law, in emergencies, or when
the information is necessary to treat you. To request
a restriction in our use or disclosure of your PHI, you
must make your request in writing to the address at
the end of this section. Your request must describe in a
clear and concise fashion: (a) the information you wish
restricted; (b) whether you are requesting to limit the
Associates’ Medical Plan’s, dental plan’s, or RFL’s use,
disclosure, or both; and (c) to whom you want the limits
to apply.
3. Right to Inspect and Copy. Except for limited
circumstances, you have the right to inspect and copy
the PHI that may be used to make decisions about you.
Usually, this includes medical and billing records. To
inspect or copy your PHI, you must submit your request
in writing to the address listed at the end of this section.
The Plans must directly provide to you, and/or the
individual you designate, access to the electronic PHI
in the electronic form and format you request, if it is
readily producible, or, if not, then in a readable electronic
format as agreed to between you and the Plan. The Plans
may charge a fee for the costs of copying, mailing, labor,
and supplies associated with your request. We may deny
your request to inspect and/or copy in certain limited
circumstances, in which case you may submit a request
to the Plan at the address in the next column that the
denial be reviewed.
4. Right to Request Amendment. You have the right to
request that we amend your PHI if you believe it is
incorrect or incomplete. To request an amendment,
you must submit a written request to the address listed
at the end of this section. You must provide a reason
that supports your request for amendment. We may
deny your request if you ask us to amend PHI that is: (a)
accurate and complete; (b) not part of the PHI kept by or
for the Plan; (c) not part of the PHI which you would be
permitted to inspect and copy; or (d) not created by the
Plan, unless the individual or entity that created the PHI
is not available to amend it. Even if we deny your request
for amendment, you have the right to submit a statement
of disagreement regarding any item in your record you
believe is incomplete or incorrect. If you request, it will
become part of your medical record and we will attach
it to your records and include it whenever we make a
disclosure of the item or statement you believe to be
incomplete or incorrect.
5. Right to an Accounting of Disclosures. You have the
right to request an accounting of disclosures. An
accounting of disclosures is a list of certain disclosures
we have made of your PHI, for most purposes other
than treatment, payment, health care operations, and
other exceptions pursuant to law or pursuant to your
authorization. To request an accounting of disclosures,
you must submit a written request to the address at the
end of this section. You must specify the time period,
which may not be longer than the six‑year period prior
to your request. We will notify you of the cost involved
in complying with your request and you may choose to
withdraw or modify your request at that time.
6. Paper Notice. You have a right to request a paper copy
of this notice, even if you have agreed to receive this
notice electronically.
If you believe your privacy rights have been violated,
you may file a complaint with the Associates’ Medical
Plan, dental plan, or RFL, or with the Secretary of the
U.S. Department of Health and Human Services. To file
a complaint with us, you must submit it in writing to the
address listed at the end of this section. Neither Walmart
nor the Plans will retaliate against you for filing a complaint.
You will not be retaliated or discriminated against and no
services, payment, or privileges will be withheld from you
because you file a complaint with the Associates’ Medical
Plan, dental plan, or RFL, or with the U.S. Department of
Health and Human Services.
If you have questions about this notice or would like to
exercise one or more of the rights listed in this notice,
please contact:
Walmart People Services
Attn: HIPAA Compliance Team
508 SW 8th Street
Mail Stop #3500
Bentonville, Arkansas 72716-3500
Email your questions to: AHWPrivacy@walmart.com
Telephone: 800-421-1362
Medicare and your prescription
drug coverage
Please read this notice about Medicare and your prescription
drug coverage carefully and keep it where you can find it.
This notice has information about your current prescription
drug coverage under the Associates’ Health and Welfare
Plan (the Plan) and your prescription drug coverage option
under Medicare. This information can help you decide
whether or not you want to join a Medicare drug plan. If you
are considering joining, you should compare your current
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coverage, including which drugs are covered at what cost,
with the coverage and costs of the plans offering Medicare
prescription drug coverage in your area. It also tells you
where to find more information to help you make decisions
about your prescription drug coverage.
There are important things you need to know about your
current coverage and Medicare’s prescription drug coverage:
• Medicare prescription drug coverage became available
in 2006 to everyone with Medicare. You can get this
coverage if you join a Medicare prescription drug plan
or join a Medicare Advantage Plan (like an HMO or PPO)
that offers prescription drug coverage. All Medicare drug
plans provide at least a standard level of coverage set by
Medicare. Some plans may also offer more coverage for a
higher monthly premium.
• Some of the Walmart prescription drug plans (as described
later in this notice under the heading Which Walmart plans
are considered creditable coverage?) are, on average for
all Plan participants, expected to pay out as much as the
standard Medicare prescription drug coverage will pay
and are therefore considered creditable coverage. If you
are a participant in one of these plans, you may keep your
current coverage and not pay a higher premium (a penalty)
if you later decide to join a Medicare drug plan.
• Other Walmart plan options (as described later in this
notice under the heading Which Walmart plans are
considered non-creditable coverage?) are, on average for
all Plan participants, not expected to pay out as much as
the standard Medicare prescription drug coverage will pay.
If you are a participant in one of these plans, your coverage
is non‑creditable coverage. This is important because for
most people enrolled in these plan options, enrolling in
Medicare prescription drug coverage means you will get
more help with drug costs than if you had prescription
drug coverage exclusively through the Plan. This is also
important because it may mean that you pay a higher
premium (a penalty) if you do not join a Medicare drug plan
when you first become eligible.
If you have non‑creditable coverage under the Plan, it may
affect how much you pay for Medicare D drug coverage
in the future. When you become eligible for Medicare D,
you should compare your current coverage, including what
drugs are covered, with the coverage and cost of the plans
offered by Medicare prescription drug coverage in your
area. Read this notice carefully — it explains your options.
CREDITABLE AND NON-CREDITABLE COVERAGE
What is the meaning of the term “creditable coverage”?
Creditable coverage means that your current prescription drug
coverage is, on average for all Plan participants, expected to
pay out as much as the standard Medicare prescription drug
coverage will pay. Prescription drug coverage that does not
satisfy this requirement is not creditable coverage.
WHICH WALMART PLANS ARE CONSIDERED
CREDITABLE COVERAGE?
Walmart has determined that the following Plans’
prescription drug coverages are considered creditable
according to Medicare guidelines:
• Premier Plan
• Contribution Plan
• Local Plans
• HMO Plans
• PPO Plan
If your coverage is creditable, you can keep your existing
coverage and not pay extra if you later decide to enroll in
Medicare coverage.
If you are enrolled in any of the Plans listed above, you
can choose to join a Medicare prescription drug plan
later without paying extra because you have existing
prescription drug coverage that, on average, is as good as
Medicare’s coverage.
If you are enrolled in Medicare Part D, you are not eligible
to enroll in any of the Plans listed above. If your dependent
is enrolled in Medicare Part D and you are not, you are
eligible to enroll in a Walmart medical or HMO plan, but
your dependent would not be eligible for coverage.
If you drop your medical coverage with Walmart and enroll
in a Medicare prescription drug plan, you and your eligible
dependents will have the option of reenrolling in the
Walmart Plan during Annual Enrollment or with a valid status
change event. You should compare your current coverage,
including which drugs are covered, with the coverage and
cost of the plans offering Medicare prescription drug
coverage in your area.
WHICH WALMART PLANS ARE CONSIDERED
NON-CREDITABLE COVERAGE?
The following Plan’s prescription drug coverage is considered
non‑creditable according to Medicare guidelines:
• Saver Plan
If your coverage is non‑creditable, you might want to
consider enrolling in Medicare prescription drug coverage
or a Walmart creditable Plan listed above because the
coverage you have is, on average for all participants, not
expected to pay out as much as the standard Medicare
prescription drug coverage will pay.
WHEN CAN I ENROLL FOR MEDICARE
PRESCRIPTION DRUG COVERAGE?
You can join a Medicare drug plan when you first become
eligible for Medicare and each year from October 15
through December 7.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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If you enroll in a Medicare Part D plan and decide within
60 days to switch back to a plan under the Walmart AMP,
you will automatically be reenrolled for the same coverage
you had prior to the status change event. See the Eligibility
and enrollment chapter for further details.
FOR MORE INFORMATION ABOUT MEDICARE
AND YOUR PRESCRIPTION DRUG COVERAGE
• You will get this notice each year before your Medicare
enrollment period.
• If we make a plan change that affects your creditable
coverage, you will receive another notice.
• If you need a copy of this notice, you can request one from
People Services at 800-421-1362.
ADDITIONAL INFORMATION AVAILABLE
More detailed information about Medicare plans that
offer prescription drug coverage is available through the
Medicare & You handbook from Medicare. You may also be
contacted directly by Medicare‑approved prescription drug
plans. You will get a copy of the handbook in the mail every
year from Medicare. You can also get more information
about Medicare prescription drug plans from these sources:
• Visit medicare.gov.
• Call your state health insurance assistance program for
personalized help. (See your copy of the Medicare & You
handbook for its telephone number.)
• Call 800-MEDICARE (800-633-4227). TTY users should
call 877-486-2048.
For people with limited income and resources, extra help
paying for the Medicare prescription drug plan is available.
For more information about this resource, visit the Social
Security Administration online at socialsecurity.gov, or call
800-772-1213 (TTY 800-325-0778).
REMEMBER
Keep this notice. If you enroll in one of the
Medicare prescription drug plans, you may
need to provide a copy of this notice when you
join to show whether or not you have creditable
coverage and therefore whether or not you are
required to pay a higher premium (a penalty).
If you have creditable prescription drug coverage and you
lose it through no fault of your own, you will be eligible
for a two‑month Special Enrollment Period (SEP) to join a
Medicare drug plan.
If you have non‑creditable prescription drug coverage and
you drop coverage under the Plan, because your coverage
is employer‑sponsored group coverage, you will be eligible
for a two‑month SEP to join a Medicare drug plan. However,
you may pay a higher premium (a penalty) because you did
not have creditable coverage under the Plan.
WHEN WILL I PAY A HIGHER PREMIUM (A
PENALTY) TO JOIN A MEDICARE DRUG PLAN?
If you have creditable coverage and drop or lose your
coverage under the Plan and do not join a Medicare drug
plan within 63 continuous days after your current coverage
ends, you may pay a higher premium (a penalty) to join the
Medicare drug plan later.
If you have non‑creditable coverage, depending on how
long you go without creditable prescription drug coverage,
you may pay a penalty to join a Medicare drug plan.
Starting with the end of the last month that you were
first eligible to join a Medicare drug plan but didn’t join,
if you go 63 continuous days or longer without creditable
prescription drug coverage, your monthly premium may
go up by at least 1% of the Medicare base beneficiary
premium per month for every month that you did not have
that coverage. For example, if you go 19 months without
creditable coverage, your premium may always be at least
19% higher than the Medicare base beneficiary premium.
You may have to pay this premium (a penalty) as long as
you have Medicare prescription drug coverage. In addition,
you may have to wait until the following Medicare annual
enrollment period beginning in October to join.
WHAT HAPPENS TO YOUR CURRENT
COVERAGE IF YOU DECIDE TO JOIN A
MEDICARE DRUG PLAN?
If you decide to join a Medicare drug plan, your current
coverage under the Associates’ Medical Plan (AMP) will
be affected. Plan guidelines restrict you from enrolling
in the AMP if you are enrolled in Medicare Part D. If your
dependent is enrolled in Medicare Part D and you are not,
you are able to enroll in the AMP, but your dependent would
not be eligible for coverage.
If you decide to join a Medicare drug plan and drop your
coverage under the Walmart AMP, be aware that you and
your dependents will be able to get your AMP coverage
back, but only during Annual Enrollment or due to a status
change event.
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Premium assistance under Medicaid
and the Children’s Health Insurance
Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and
you’re eligible for health coverage from Walmart Inc., your
state may have a premium assistance program that can help
pay for coverage, using funds from their Medicaid or CHIP
programs. If you or your children aren’t eligible for Medicaid
or CHIP, you won’t be eligible for these premium assistance
programs but you may be able to buy individual insurance
coverage through the Health Insurance Marketplace.
For more information, visit healthcare.gov.
If you or your dependents are already enrolled in Medicaid
or CHIP and you live in a state listed below, contact your
state Medicaid or CHIP office to find out if premium
assistance is available.
If you or your dependents are NOT currently enrolled
in Medicaid or CHIP, and you think you or any of your
ALABAMA – Medicaid
Website: http://myalhipp.com
Phone: 855-692-5447
ALASKA – Medicaid
The AK Health Insurance Premium Payment Program
Website: http://myakhipp.com
Phone: 866-251-4861
Email: CustomerService@MyAKHIPP.com
Eligibility:
http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
ARKANSAS – Medicaid
Website: http://myarhipp.com
Phone: 855-MyARHIPP (855-692-7447)
CALIFORNIA – Medicaid
Website: Health Insurance Premium Payment (HIPP) Program
https://www.dhcs.ca.gov/hipp
Phone: 916-445-8322
Email: hipp@dhcs.ca.gov
COLORADO – Health First Colorado (Medicaid) & Child
Health Plan Plus (CHP+)
Health First Colorado website:
https://www.healthfirstcolorado.com
Health First Colorado Member Contact Center:
800-221-3943 State Relay 711
CHP+:
https://www.colorado.gov/pacific/hcpf/child-health-plan-plus
CHP+ Customer Service:
800-359-1991 / State Relay 711
Health Insurance Buy‑In Program (HIBI):
https://www.colorado.gov/pacific/hcpf/health-insurance-
buy-program
HIBI Customer Service: 855-692-6442
FLORIDA – Medicaid
Website: https://www.flmedicaidtplrecovery.com/
flmedicaidtplrecovery.com/hipp/index.html
Phone: 877-357-3268
GEORGIA – Medicaid
Website: https://medicaid.georgia.gov/health-insurance-
premium-payment-program-hipp
Phone: 678-564-1162 ext 2131
INDIANA – Medicaid
Healthy Indiana Plan for low‑income adults 19‑64
Website: http://www.in.gov/fssa/hip
Phone: 877-438-4479
All other Medicaid
Website: https://www.in.gov/medicaid
Phone: 800-457-4584
IOWA MEDICAID AND CHIP (Hawki)
Medicaid website: https://dhs.iowa.gov/ime/members
Medicaid phone: 800-338-8366
Hawki website: http://dhs.iowa.gov/Hawki
Hawki phone: 800-257-8563
HIPP website:
https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp
KANSAS – Medicaid
Website: http://www.kancare.ks.gov
Phone: 800-792-4884
KENTUCKY – Medicaid
Kentucky Integrated Health Insurance Premium Payment
Program (KI‑HIPP) website:
https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx
Phone: 855-459-6328
Email: KIHIPP.program@ky.gov
KCHIP website: https://kidshealth.ky.gov/Pages/index.aspx
Phone: 877-524-4718
Medicaid website: https://chfs.ky.gov
LOUISIANA – Medicaid
Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp
Phone: 888-342-6207 (Medicaid hotline) or
855-618-5488 (LaHIPP)
MAINE – Medicaid
Enrollment website: https://www.maine.gov/dhhs/ofi/
applications-forms
Phone: 800-442-6003
TTY: Maine relay 711
Private health insurance premium webpage:
https://www.maine.gov/dhhs/ofi/applications-forms
Phone: 800-977-6740
TTY: Maine relay 711
MASSACHUSETTS – Medicaid and CHIP
Website: http://www.mass.gov/info-details/masshealth-
premium-assistance-pa
Phone: 800-862-4840
MINNESOTA – Medicaid
Website: https://mn.gov/dhs/people-we-serve/children-and-
families/health-care/health-care-programs/programs-and-
services/other-insurance.jsp
Phone: 800-657-3739
MISSOURI – Medicaid
Website:
http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 573-751-2005
MONTANA – Medicaid
Website:
http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 800-694-3084
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
dependents might be eligible for either of these programs,
contact your state Medicaid or CHIP office or dial
877-KIDS NOW or insurekidsnow.gov to find out how to
apply. If you qualify, ask your state if it has a program that
might help you pay the premiums for the Plan.
a “special enrollment” opportunity, and you must request
coverage within 60 days of being determined eligible for
premium assistance. If you have questions about enrolling
in your employer plan, contact the Department of Labor at
askebsa.dol.gov or call 866-444-EBSA (3272).
If you or your dependents are eligible for premium assistance
under Medicaid or CHIP, as well as eligible under the Walmart
Inc. Plan, the Plan must allow you and your dependents to
enroll in the Plan if you aren’t already enrolled. This is called
If you live in one of the following states, you may be eligible
for assistance paying your employer health plan premiums.
The following list of states is current as of July 31, 2021.
Contact your state for more information on eligibility.
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NEBRASKA – Medicaid
Website: http://www.ACCESSNebraska.ne.gov
Phone: 855-632-7633
Lincoln: 402-473-7000
Omaha: 402-595-1178
NEVADA – Medicaid
Website: http://dhcfp.nv.gov
Phone: 800-992-0900
NEW HAMPSHIRE – Medicaid
Website: https://www.dhhs.nh.gov/oii/hipp.htm
Phone: 603-271-5218
Toll‑free for HIPP program: 800-852-3345, ext 5218
NEW JERSEY – Medicaid and CHIP
Medicaid website: http://www.state.nj.us/humanservices/
dmahs/clients/medicaid
Medicaid phone: 609-631-2392
CHIP website: http://www.njfamilycare.org/index.html
CHIP phone: 800-701-0710
NEW YORK – Medicaid
Website: https://www.health.ny.gov/health_care/medicaid
Phone: 800-541-2831
NORTH CAROLINA – Medicaid
Website: https://medicaid.ncdhhs.gov
Phone: 919-855-4100
NORTH DAKOTA – Medicaid
Website:
http://www.nd.gov/dhs/services/medicalserv/medicaid
Phone: 844-854-4825
OKLAHOMA – Medicaid and CHIP
Website: http://www.insureoklahoma.org
Phone: 888-365-3742
OREGON – Medicaid
Website: http://healthcare.oregon.gov/Pages/index.aspx
http://www.oregonhealthcare.gov/index-es.html
Phone: 800-699-9075
PENNSYLVANIA – Medicaid
Website: https://www.dhs.pa.gov/providers/Providers/
Pages/Medical/HIPP-Program.aspx
Phone: 800-692-7462
RHODE ISLAND – Medicaid and CHIP
Website: http://www.eohhs.ri.gov
Phone: 855-697-4347, or 401-462-0311 (Direct RIte Share Line)
SOUTH CAROLINA – Medicaid
Website: https://www.scdhhs.gov
Phone: 888-549-0820
SOUTH DAKOTA – Medicaid
Website: http://dss.sd.gov
Phone: 888-828-0059
TEXAS – Medicaid
Website: http://gethipptexas.com
Phone: 800-440-0493
UTAH – Medicaid and CHIP
Medicaid website: https://medicaid.utah.gov
CHIP website: http://health.utah.gov/chip
Phone: 877-543-7669
VERMONT – Medicaid
Website: http://www.greenmountaincare.org
Phone: 800-250-8427
VIRGINIA – Medicaid and CHIP
Website: https://www.coverva.org/en/famis-select
https://www.coverva.org/en/hipp
Medicaid/CHIP phone: 800-432-5924
WASHINGTON – Medicaid
Website: https://www.hca.wa.gov
Phone: 800-562-3022
WEST VIRGINIA – Medicaid
Website: http://mywvhipp.com
Phone: 855-MyWVHIPP (855-699-8447)
WISCONSIN – Medicaid and CHIP
Website:
https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm
Phone: 800-362-3002
WYOMING – Medicaid
Website: https://health.wyo.gov/healthcarefin/medicaid/
programs-and-eligibility
Phone: 800-251-1269
To see if any other states have added a premium assistance program since July 31, 2021, or for more information on special
enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
dol.gov/ebsa
866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
cms.hhs.gov
877-267-2323, Menu Option 4, Ext. 61565
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Valued Plan Participant
THE ASSOCIATES’ HEALTH AND WELFARE PLAN (AHWP) RESPECTS THE DIGNITY OF
EACH INDIVIDUAL WHO PARTICIPATES IN THE PLAN.
The AHWP does not discriminate on the basis of race,
color, national origin, sex, age, or disability and strictly
prohibits retaliation against any person making a complaint
of discrimination. Additionally, we gladly provide our
participants with language assistance, auxiliary aids and
services at no cost. We value you as our participant and
your satisfaction is important to us.
To learn about or use our grievance process, contact
People Services at 1‑800-421-1362.
To file a complaint of discrimination, contact the U.S.
Department of Health and Human Services, Office of
Civil Rights:
Phone: 1‑800-368-1019 or 1‑800-537-7697 (TDD)
If you need such assistance or have concerns with your Plan
services, please call the number on the back of your plan
ID card. If you have any questions or concerns, please use
one of the methods below so that we can better serve you.
For assistance, call the number on the back of your plan
ID card.
Website: https://ocrportal.hhs.gov/ocr/cp/wizard_cp.jsf
Email: OCRComplaint@hhs.gov
Interpreter services are available at no cost:
1-800-421-1362.
Português (Brasil)
Serviços de interprete estão disponíveis grátis.
1‑800‑421‑1362.
Română
Serviciile de interpretariat sunt disponibile gratuit.
1‑800‑421‑1362.
Af‑Soomaali
Adeegyada Turjumaanka waxaa lagu heli karaa kharash la’aan.
1‑800‑421‑1362.
Español
Los servicios de interpretación están disponibles de manera
gratuita. 1‑800‑421‑1362.
Kiswahili
Huduma za tafsiri zipo bila malipo. 1‑800‑421‑1362.
Français
Des services d’interprètes sont disponibles sans frais.
1‑800‑421‑1362.
kreyòl ayisye
Gen Sèvis entèprèt ki disponib gratis. 1‑800‑421‑1362.
Polski
Usługi tłumacza dostępne są bez żadnych kosztów.
1‑800‑421‑1362.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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The Associate Stock
Purchase Plan (ASPP)
Associate Stock Purchase Plan eligibility
Enrolling in the Associate Stock Purchase Plan
Walmart’s contribution to your company stock ownership
Selling stock through the Plan
Keeping track of your Computershare account
Ending your participation and closing your account
If you leave the company
PROSPECTUS
Introduction and overview
Plan administration; account management
Plan participation and eligibility
Plan contributions — Associate Stock Purchase Program
Stock ownership, fees, and risks
Stock certificate delivery and Stock sales
Termination of participation; account closure
Plan amendment and termination
Tax information
Available information
Electronic delivery of prospectuses and other documents
Documents incorporated by reference
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2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
The Associate Stock Purchase Plan (ASPP)
The Associate Stock Purchase Plan (ASPP or Plan) allows you to buy Walmart stock conveniently
through payroll deductions and through direct payments to the Plan Administrator. You can have
any amount from $2 to $1,000 withheld from your biweekly paycheck ($1 to $500 if you are paid
weekly) to buy stock. Walmart matches $0.15 for every dollar that you contribute through payroll
deduction to purchase stock, up to the first $1,800 you contribute to the Plan in each Plan year
(April through March).
RESOURCES
Find What You Need
Online
Other Resources
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Enroll in the Plan or change your
deduction amount
Complete an online enrollment session
on One.Walmart.com/ASPP
• Access your account information
• Get your account statement
• Get a Form 1099
Go to the Computershare website at
computershare.com/walmart or the
Associate Stock app
Send money directly to Computershare
Call Computershare at 800-438-6278
(hearing impaired: 800-952-9245) or get
the Associate Stock app (available for
Apple or Android devices)
Send check to:
Computershare
Attn: Walmart ASPP
P.O. Box 505042
Louisville, Kentucky 40233
(Company matching contributions will
not be made on money sent directly to
Computershare)
What you need to know about the Associate Stock Purchase Plan
• All eligible associates can purchase Walmart stock through convenient payroll deductions and direct payments
to Computershare.
• Walmart matches $0.15 for every $1 you put into the Plan through payroll deductions, up to the first $1,800 that
you contribute in each plan year.
• There are no fees to purchase shares of Walmart stock through the Plan. You only pay a fee when you sell shares of stock.
• Your shares will be credited to an account that is maintained in your name at Computershare. You can access your
account online, by telephone, or app (see Resources chart above) to get your balance or sell stock held in your account.
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Associate Stock Purchase
Plan eligibility
You are eligible to enroll in the Associate Stock Purchase
Plan if you are:
• Not a member of a collective bargaining unit whose
benefits were the subject of good faith collective
bargaining.
• At least 18 years of age or the legal age of majority in your
payroll state to participate (19 is the legal age of majority
in Alabama and Nebraska). If you live in Puerto Rico,
you must be 21 years of age to participate. If you have
questions about the age requirement, review your state
laws on legal age of majority.
Enrolling in the Associate Stock
Purchase Plan
You can enroll in the Plan by completing an online
benefits enrollment session on One.Walmart.com/ASPP.
Before you enroll in this plan, you should carefully review
this Associate Stock Purchase Plan brochure and the Plan
Prospectus (a copy of which appears on the following
pages), as well as the reports and other documents that
the company has incorporated by reference into the
Plan Prospectus.
The decision to participate in the Plan and to purchase
company stock is an individual decision to be made solely
by you. The company is not recommending, endorsing,
or soliciting your participation in the Plan or purchase of
company stock. In making your decision, you should be
aware that the past performance of the company stock
is not an indication or prediction of future performance.
The value of company stock may be affected by many
factors, including those outside the company itself,
such as economic conditions. The company urges you to
consult with your financial and tax advisors regarding your
participation in the Plan and investment in company stock.
Walmart’s contribution to your
company stock ownership
The Associate Stock Purchase Plan allows all eligible
associates to buy Walmart stock conveniently through
payroll deductions. You can have any whole dollar amount
from $2 to $1,000 withheld from your paycheck to buy stock
($1 to $500 for associates with a weekly paycheck).
Walmart contributes to your stock purchase account by
matching $0.15 for every $1 you contribute to the Plan
through payroll deductions, up to your first $1,800 you
contribute in each Plan year. The Plan year runs from April
through March. The company match is reflected as income
on your check stub and on your Form W‑2.
In addition to your payroll deductions, you can also contribute
to the Associate Stock Purchase Plan by sending money
directly to Computershare, the Plan’s administrator, at:
Computershare
Attn: Walmart ASPP
P.O. Box 505042
Louisville, Kentucky 40233
Money sent directly to Computershare will not receive the
Walmart matching contribution. The total of your payroll
deductions and money sent directly to Computershare
cannot exceed $125,000 per Plan year. Dividends paid on
the stock you hold as of each dividend record date are
automatically reinvested to buy additional shares of stock
for you, but do not count against the $125,000 maximum.
The value of the stock you purchase can fluctuate and may
decline. There is no way to guarantee that your stock will
have the same value in the future that it had when you made
the purchase or that the value of the stock will increase.
When making a decision about purchasing Walmart stock,
consider all your investments, including other Walmart stock
you may own. For investment questions, consult a financial
advisor. Investment in the stock is subject to certain risks
as described in the Plan Prospectus and Walmart’s most
recent Annual Report on Form 10‑K that is incorporated by
reference in the Plan Prospectus.
WALMART’S CONTRIBUTION TO YOUR COMPANY STOCK OWNERSHIP
If you contribute
Your Plan year payroll deduction
contribution is
Walmart’s matching
contribution* is
Total amount used to purchase
Walmart stock
$10 biweekly
$20 biweekly
$70 biweekly
$260
$520
$1,820
$39
$78
$270 (Walmart matches $0.15
for every $1 up to $1,800)
$299
$598
$2,090
* Company contributions will be made only on stock purchased through payroll deductions. Company contributions will not be made on
money sent directly to Computershare.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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Selling stock through the Plan
No fees are charged to you for buying stock; however, when
you sell stock you will be charged a fee. The fees charged by
Computershare as described in this section are subject to
change from time to time.
If you choose to sell your stock, your stock will be sold
pursuant to a market order. Your stock will be sold as soon
as your request can reasonably be processed. Generally,
market orders are executed immediately after they are
placed. The price at which your order will be executed is
not guaranteed, and the Walmart stock price prior to the
execution of your order is not necessarily the price at which
your order will be executed.
Generally, any sales of your stock will be executed over the
New York Stock Exchange (NYSE). If the NYSE is closed
when your order is ready to be processed, your order will be
processed as early as possible on the next NYSE trading day.
The fee is $25.50 per sale plus $0.05 (five cents) per share
sold for each sell you execute.
You can sell stock from computershare.com/walmart, from
the Associate Stock app (available for Apple and Android
devices), or by calling Computershare at 800-438-6278
(hearing impaired: 800-952-9245). You can choose to have
your proceeds deposited to a bank account on file or have
a check mailed to the address on file at Computershare.
If you choose to deposit your proceeds in a bank account,
your funds are sent to the bank on the trade settlement
date, which is two business days from the date of sale. If
you select to receive your proceeds via check, you should
receive your check within seven to 10 business days after
you place an order to sell stock in your Plan account.
The sale fee is automatically deducted from the amount
deposited or reported on your check for the net proceeds
of the sale. Each time you sell stock, you will receive a
transaction summary form. For tax reporting purposes,
you’ll receive appropriate tax documents (1099B and/or
1099DIV) enclosed with your annual statement in the first
quarter of the following year (January through March).
Depending on delivery preference, these documents will be
either mailed to your address on file with Computershare
or you will be notified via email when they are available.
You should use these documents when filing your taxes.
It’s important to understand the tax consequences of a
stock sale. If you have tax‑related questions, please consult
a financial advisor or tax consultant.
Keeping track of your
Computershare account
You will receive a statement from Computershare at
least annually (first quarter) that shows the activity in
your account. However, if you opted to receive your
statements electronically, you will receive an email
informing you that your statement is ready and can be
found on computershare.com/walmart.
The annual statement you receive will contain important
tax information. It is very important that you keep your
statement so that you will know the difference between
your purchase price and sale price of any shares of stock you
sell. You will need this information for your income taxes.
You can access your account information online at
computershare.com/walmart, by the Associate Stock app
(available for Apple and Android devices), or by phone at
800-438-6278 (hearing impaired: 800-952-9245).
If you request replacement statements from
Computershare, there is a $5 charge per statement for
previous years’ statements. Or, you can obtain copies free of
charge through the website at computershare.com/walmart.
Ending your participation and
closing your account
To cancel your payroll deductions to the Associate Stock
Purchase Plan, complete an online benefit enrollment session
on One.Walmart.com/ASPP.
After you cancel your payroll deductions, you can close
your account by selling or transferring the remaining
stock in your account. To avoid paying a sales transaction
fee twice, cancel your payroll deductions before closing
your account. You also have the option to stop payroll
deductions and to continue to hold your shares through the
Plan at Computershare.
If you leave the company
If you leave the company, you will have several options
concerning the status of your account:
• You can keep your account open without the weekly or
biweekly payroll deduction and the company match. You
can make voluntary cash purchases and benefit from
having no broker’s fee. There is an annual maintenance fee
of $35 per year, which will be automatically deducted from
your account through the sale of an appropriate number
of shares or portion of a share of stock to cover the fee
during the first quarter of the year.
• You can close your account and transfer your shares to
another brokerage.
• You can close your account and sell some or all of the
shares in your account.
In order to prevent any residual balances and to avoid paying
a sales transaction fee twice, wait until you receive your
final paycheck before closing your account.
It is very important that you update Computershare if you
have an address change after you have left the company.
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Prospectus
This document below constitutes a prospectus covering securities that have been registered
under the Securities Act of 1933.
50,935,077 Shares
WALMART INC.
Common Stock
($.10 par value per share)
WALMART INC.
2016 Associate Stock Purchase Plan
(formerly, the Wal‑Mart Stores, Inc. 2016 Associate Stock Purchase Plan,
the Wal‑Mart Stores, Inc. 2004 Associate Stock Purchase Plan,
and the Walmart Stores, Inc. Associate Stock Purchase Plan of 1996)
This prospectus relates to the purchase of the number of shares of the common stock, $0.10 par value per share, of Walmart
Inc. (“Walmart,” the “Company” or “we”) shown above under the Walmart Inc. 2016 Associate Stock Purchase Plan (the
“Plan”) by eligible Walmart associates who elect to participate in the Plan.
These securities have not been approved or disapproved by the Securities and Exchange Commission or any state securities
commission nor has the Securities and Exchange Commission or any state securities commission passed upon the accuracy
or adequacy of this prospectus. Any representation to the contrary is a criminal offense.
No one is authorized to give any information or to make any representations other than those contained in this Prospectus
and, if given or made, you should not rely on them. This Prospectus is not an offer to sell or a solicitation of an offer to buy
any of the securities referred to in this Prospectus in any state or other jurisdiction where such an offer or solicitation would
be unlawful. Neither the delivery of this Prospectus nor acquisition of securities described in this Prospectus implies that no
change in the affairs of the company has occurred since the date of this Prospectus.
Investment in shares of the Common Stock offered hereby involves certain risks. See “Part I, Item 1A. Risk Factors” in
Walmart’s Annual Report on Form 10‑K most recently filed with the Securities and Exchange Commission for a discussion of
certain risks that may affect our business, operations, financial condition, results of operations and cash flows. See “Stock
Ownership, fees and risks” below.
The date of this Prospectus is June 30, 2021
Introduction and overview
The Plan is an amendment and restatement of the Wal‑
Mart Stores, Inc. 2004 Associate Stock Purchase Plan
which had previously amended and restated the Wal‑Mart
Stores, Inc. Associate Stock Purchase Plan of 1996. The
Plan was most recently approved by the stockholders of
Walmart at our Annual Stockholders’ Meeting held on June
3, 2016. As of June 30, 2021, up to 50,935,077 shares of
the company’s common stock, par value $.10 per share (the
“Stock”), were available for purchase from the company
or on the open market under the Plan; 20,000,000 shares
of Stock were available for purchase from the company
under the Plan; and 30,000,000 shares of Stock were
available for purchase on the open market under the
Plan. On November 30, 2018, 50,000,000 shares were
registered with the United States Securities and Exchange
Commission for offer and sale on Registration Statements
on Form S‑8. Shares of the Stock are listed for trading on
the New York Stock Exchange. Participating associates may
be referred to as “you” in this Prospectus.
The Plan has two parts — the Stock Purchase Program and
the Outstanding Performance Award Program. The Stock
Purchase Program gives eligible associates an opportunity
to share in company ownership by allowing them to purchase
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shares of Stock by payroll deduction. In addition, if they make
or have made purchases through such payroll deductions
under the Plan, they may also purchase shares of Stock by
making voluntary contributions to the Plan out of their other
funds. Under the Outstanding Performance Award Program,
the company may reward associates for exceptional job
performance by awarding shares of Stock to them.
We believe that the Plan is not subject to any provisions of
the Employee Retirement Income Security Act of 1974, as
amended. The Plan is not qualified under Section 401(a) or
423 of the Internal Revenue Code of 1986, as amended.
Plan administration;
account management
The Plan provides that the Compensation and Management
Development Committee of our Board of Directors (the
“Committee”) has the overall authority for administering
the Plan. The Committee may delegate (and revoke the
delegation of) some or all aspects of Plan administration
to the officers or managers of the company or of a
wholly‑owned or majority‑owned subsidiary of the company
(which subsidiaries are referred to in this Prospectus as
“affiliates”), subject to terms as it deems appropriate. The
members of the Committee are selected by Walmart’s
Board of Directors. The Board of Directors may remove a
member from the Committee at its discretion, and a member
will cease to be a Committee member if he or she ceases
to be a director of Walmart for any reason. At the date
of this Prospectus, the members of the Committee were
Mr. Steve Reinemund, Ms. Carla Harris, Ms. Marissa Mayer,
and Mr. Randall Stephenson.
The Committee has selected a Third‑Party Administrator,
currently Computershare Trust Company, N.A.
(“Computershare”), to establish and maintain accounts
under the Plan. Computershare also serves as the company’s
stock transfer agent and provides other stock‑related
services to the company and its shareholders.
The Committee, as administrator of the Plan, or its delegate,
must follow the terms of the Plan, but otherwise has full
power and discretion to administer the Plan, including, but
not limited to, the power to: (i) determine when, to whom
and in what types and amounts contributions should be
made; (ii) authorize the company to make contributions to
eligible associates in any number and to determine the terms
and conditions applicable to each such contribution; (iii) set
a minimum and maximum dollar, share or other limitation
on the various contributions permitted under the Plan;
(iv) determine whether an entity of which we own more than
50% or otherwise control, directly or indirectly (an “affiliate”)
should become (or cease to be) a Participating Employer (as
defined below); (v) determine whether (and which) associates
of non‑U.S. Participating Employers should be eligible to
participate in the Plan; (vi) make all determinations deemed
necessary or advisable for the administration of the Plan;
(vii) make, amend, waive and rescind rules and regulations for
the administration of the Plan; and (viii) exercise any powers,
perform any acts and make any determinations it deems
necessary or advisable to administer the Plan. All decisions
made by the Committee under the Plan are final and binding
on all persons, including the company and its affiliates, any
associate, any person claiming any rights under the Plan
from or through any participant, and shareholders of the
company. The members of the Committee do not act as the
trustees of the participants or hold the Stock credited to
the participants’ Plan accounts, any funds contributed to the
Plan by any associate or the proceeds of any sale of shares of
stock in trust for the benefit of the participants.
Plan participation and eligibility
If you are eligible to participate in the Plan, you can
become a participant in the Plan by enrolling online at
One.Walmart.com/ASPP to authorize payroll deductions to
be taken from your regular compensation and contributed
to the Plan for the purchase of Stock to be held in your
Plan account. You can also become a participant in the Plan
if the Committee grants you an award of Stock under the
Outstanding Performance Award Program.
All associates of the company and approved affiliates of
the company (“Participating Employers”) are eligible to
participate in the Plan, except:
• If you are restricted or prohibited from participating in the
Plan under the law of your state or country of residence,
you may not participate in the Plan or your participation in
the Plan may be limited. It is your responsibility to ensure
there are no such restrictions or prohibitions on your
participation in the Plan.
• You must have attained the age of majority in your state
of residence or employment to participate. It is your
responsibility to ensure you are of sufficient age to
participate. The company may terminate your participation
if it discovers you are not of legally sufficient age to
participate in the Plan.
• If you are a member of a collective bargaining unit
whose benefits were the subject of good faith collective
bargaining, you are excluded from participation in the Plan.
• If your employer is a non‑U.S. Participating Employer,
you may participate only if you are an approved associate
(listed by group, category or by individual).
• If you are an officer of Walmart subject to subsection
16(a) of the Securities Exchange Act of 1934, or otherwise
subject to our Insider Trading Policy, your ability to change
your biweekly deduction amounts, acquire, or sell shares of
Stock may be restricted at certain times.
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If you are on a bona fide leave of absence from the company
or a Participating Employer, you will continue to be eligible
to make contributions to the Plan during your leave of
absence, but you will not be eligible for company matching
contributions during that time. If you are on a military
leave of absence from the company or a Participating
Employer, please contact the Benefits Department to
see whether you are eligible to receive company matching
contributions during your leave. Please note that you must
make contributions from your own funds if you are not
receiving a paycheck while you are on a leave of absence, as
payroll deduction would not be available as an option. Any
other circumstances which would permit you to continue to
participate in the Plan while on a leave must be approved by
the Committee.
Plan contributions — Associate Stock
Purchase Program
To make payroll deduction contributions, you need
to complete an online benefits enrollment session at
One.Walmart.com. Once you have properly enrolled in
the Plan, your payroll deduction contributions will continue
in accordance with your most recent payroll deduction
authorization (subject to any restrictions imposed by the
Plan) as long as you are employed by the company or a
Participating Employer, unless you change or terminate
your payroll deduction authorization or the Plan itself
is terminated.
Please note that no deduction will be drawn from any
paycheck in which your payroll deduction contribution
exceeds your net pay after taxes are withheld. You can
change or terminate your payroll deduction authorization
by completing an online benefits enrollment session at
One.Walmart.com. Your request will be processed as soon
as practicable. Your enrollment or request may be delayed
or rejected if your enrollment or requested change is
prohibited at the time of the attempted enrollment or the
request by any company policy, including the company’s
Insider Trading Policy.
Note that payroll deduction contributions are generally
taken from your last paycheck as an associate. If you do not
want to have payroll deduction contributions taken from
your last paycheck, it is important that you timely terminate
your payroll deduction authorization. If you work in a state
that requires your last paycheck to be paid outside of the
normal payroll cycle, payroll deduction contributions will
not be taken out of your last paycheck.
Payroll deductions can be as little as $2 or as much as
$1,000 per biweekly payroll period. Payroll deductions
for associates paid on a weekly basis can be as little as
$1 or as much as $500 per weekly payroll period. The
amount of any biweekly or weekly deduction in excess of
the minimum must be in $1 increments. The Company or
your Participating Employer will make a matching cash
contribution on your behalf to your Plan account when you
make contributions to the Plan by payroll deduction. The
matching contribution is currently 15 percent of the first
$1,800 you contribute to the Plan by payroll deduction,
or up to $270 per Plan year. The company’s matching
contribution will be used to buy Stock for your Plan account.
If you participate or have participated in payroll deductions
under the Plan and your Plan account has not been closed
as described below, you can also voluntarily contribute
cash (in U.S. dollars) from your other resources to fund
the purchase of Stock under the Plan to be held in your
Plan account, including after your employment with
the Company or any Participating Employer has been
terminated. Any voluntary contributions must be made
directly to Computershare. Instructions for making such
voluntary contributions are available from Computershare.
Neither the Company nor your Participating Employer will
make matching contributions on amounts you contribute
directly to Computershare. In addition, you may also deposit
shares of Stock that you hold outside of the Plan (whether
you originally acquired those shares through the Plan or
otherwise) to your Plan account by making arrangements
directly with Computershare.
The total of your payroll deductions and voluntary cash
contributions to the Plan cannot exceed $125,000 per Plan
year (April 1 through March 31). Dividends credited to your
Plan account will not count against the maximum.
The Committee establishes and may change the maximum
and minimum contributions, may change the conditions for
voluntary cash or Stock contributions, and may change the
amount of the matching contributions of an employer at
any time.
OUTSTANDING PERFORMANCE
AWARD PROGRAM
Under the Outstanding Performance Award component,
you can be granted an award of Stock for demonstrating
consistently outstanding performance in your job over
the period of a month, a quarter or a year. The Committee
approves all Outstanding Performance Awards and sets
maximum dollar limitations on these awards from time
to time.
Your Stock under the Outstanding Performance Award
component will be given to you through an account
maintained for your benefit by Computershare.
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STOCK PURCHASES
Your employer will send all of your payroll deductions along
with any matching contributions to Computershare as soon
as practicable following each pay period. Computershare
will purchase Stock for your Plan account no later than
five business days after it receives the funds. If you make a
voluntary cash contribution outside of payroll deductions,
Computershare will purchase your Stock with that voluntary
cash contribution no later than five business days after it
receives the funds.
Computershare may purchase Stock for the Plan accounts
on a national stock exchange, from the company, or from
a combination of these places. However, the Committee
reserves the right to direct Computershare to purchase from
a particular source, consistent with applicable securities rules
and the applicable rules of any national stock exchange.
Typically, when Computershare purchases Stock for the
Plan on a national stock exchange, the shares are purchased
as part of a bundled group rather than individually for
each participant. In some instances, the shares of Stock
for a bundled group must be purchased for the Plan over
more than one day. When shares of Stock are purchased
for you as part of a bundled group, your purchase price for
each share of Stock will be equal to the average price of all
shares of Stock purchased for that group as determined by
Computershare. A participant is not permitted to direct an
order for Computershare to purchase shares of Stock solely
for himself or herself that are part of the bundled group.
If Computershare buys shares of Stock from the company,
whether authorized but unissued shares or treasury shares,
the per‑share price paid to the company for those shares
of Stock will be equal to the Volume Weighted Average
Price (VWAP) as reported on the New York Stock Exchange
— Composite Transactions on the date of purchase. The
VWAP is the weighted average of the prices at which all
trades of the company’s Stock are made on the NYSE on
the date of the Stock is purchased from the company.
While the Plan permits the Committee to designate
another methodology for valuing Stock purchased from
the company, as of the date of this Prospectus no other
methodology has been designated.
The number of shares allocated to your Plan account in
connection with any purchase of Stock will equal the total
amount of the contributions and dividends available for your
Plan account and used to fund such purchases, divided by
the purchase price for each share of Stock attributable to
those purchases as discussed above.
Non-U.S. Participants Please Note: All amounts contributed
to the Plan by payroll deduction, all matching contributions,
and any contributions made pursuant to the Outstanding
Performance Award component will be converted from
your local currency to U.S. dollars prior to the time the
shares of Stock are purchased. Generally, the exchange
rate used is the one for the business day immediately prior
to the day the funds are sent to Computershare, but that
may not be practicable in all circumstances. All voluntary
cash contributions must be converted to U.S. dollars before
being sent to Computershare to purchase shares of Stock.
Stock ownership, fees, and risks
STOCK OWNERSHIP
From the time that shares of Stock are credited to your
Plan account, you will have full ownership of those shares
(including any fractional shares) of Stock. The shares
of Stock held in your Plan account will be registered in
Computershare’s name until you request to have your
shares deposited into a “General Shareholder” account,
have your Stock certificates delivered to you from the
Plan account, or you sell the shares credited to your Plan
account. You may not assign or transfer any interest in the
Plan before shares are credited to your account. However,
you may sell, transfer, assign or otherwise deal with your
shares of Stock credited to your Plan account once they
are credited to your Plan account, just like any other
stockholder of the company. You may not transfer or
assign your Plan account to another person who is not an
eligible participant in the Plan. There is no automatic lien
or security interest on the shares of Stock held in your
Plan account, and the terms of the Plan do not provide
for anyone to have or to have the ability to create a lien
on any funds or shares of Stock credited to your Plan
account. However, you may pledge, hypothecate or deal
with the shares of Stock credited to your Plan accounts
in the same manner as you may do with other shares of
Stock you may own, subject to compliance with our Insider
Trading Policy.
DIVIDENDS AND VOTING
Dividends on shares in your account will be automatically
reinvested in additional shares of Stock. You will be able to
direct the vote on each full share of Stock held in your Plan
account, but not fractional shares. You will receive at no
cost and as promptly as practicable (by mail or otherwise)
all notices of meetings, proxy statements, notices of
internet availability of proxy materials and other materials
distributed by the company to its stockholders. To vote the
shares of Stock held in your Plan account, you must deliver
signed voting instructions, also known as proxy instructions,
in a timely manner described in the company’s proxy
materials. If you do not provide properly completed and
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executed voting instructions as described in the company’s
proxy materials, your shares will not be voted with respect
to any election of directors, any advisory vote on executive
compensation, or many other matters that may be subject
to a shareholder vote. However, in those circumstances,
your shares of Stock may be voted in the manner
recommended by the company in its proxy statement or as
directed by the Committee on matters defined by the New
York Stock Exchange as “routine,” such as the ratification of
the appointment of the company’s independent auditors,
provided that doing so would comply with applicable law and
any applicable listing standard of a national stock exchange.
FEES AND ACCOUNT STATEMENTS
The company pays all fees associated with the purchase of
Stock. Generally, no maintenance fees or other charges
will be assessed to your Plan account as long as you are
employed by the company or one of its affiliates (even if
that affiliate is not a Participating Employer). However,
you must pay any commissions or charges resulting from
other Computershare services you request, for example,
brokerage commissions and other fees applicable to the sale
of Stock. Computershare can tell you if a particular request
would cause you to incur a charge. The fees charged by
Computershare described in this Prospectus are subject to
change from time to time.
At least annually, you will receive a statement of your
account under the Plan, reflecting all activity with respect
to your Plan account for the period of time covered by the
statement. You may elect to receive your statements online.
If you elect to do so, you will receive an email informing
you that your statement is ready and can be found on
computershare.com/walmart. Your annual statement will
also contain important tax information. It is very important
that you keep your statement so that you will know the
difference between your purchase price and sales price of
any shares of Stock you sell. You will need this information
for your income taxes.
You may also access information regarding your account
at any time by logging on to computershare.com/walmart
or the Associate Stock app. You can access your account
information by phone at 800-438-6278 (hearing impaired
800-952-9245).
If you request replacement statements from
Computershare, there is currently a $5 charge per statement
for statements for years preceding the most recently
completed plan year. Or, you can obtain copies free of
charge through the website at computershare.com/walmart.
RISKS
Many of your risks of Plan participation are the same as
those of any other stockholder of the company, in that you
assume the risk that the value of the Stock may increase
or decrease. There are no guarantees as to the value of
a share of Stock. This means that you assume the risk of
fluctuations in the value or market price of the Stock.
Our latest Annual Report on Form 10‑K filed with the SEC
and, as noted below, incorporated by reference in this
Prospectus, discusses, and other of our reports filed with
the SEC may discuss, certain risks relating to the company,
its operations and financial performance that can affect the
value, market price and liquidity of the Stock. The company
urges you to review those discussions in connection with
any determination to participate in the Plan, to change
the terms of your participation in the Plan, to terminate
your participation in the Plan, or to make any voluntary
contributions under the Plan.
If you are a non‑U.S. participant, you also assume the
risk of fluctuation in currency exchange rates. Also, your
payroll deductions (as well as the corresponding matching
contributions) are applied by Computershare to purchase
shares of Stock, such funds are considered general assets
of the company or the Participating Employer and, as such,
are subject to the claims of the company’s or Participating
Employer’s creditors. No interest will be paid on any
contributions to the Plan.
Stock certificate delivery and
Stock sales
Computershare will send you, on request, a stock certificate
representing any or all full shares of Stock credited to
your Plan account at no cost to you. Your shares that are
represented by a stock certificate will no longer be credited
or otherwise related to any Plan account that you continue
to have in effect and the dividends those shares will not be
reinvested under the Plan.
You may also have Computershare transfer any or all of
the shares of Stock credited to your Plan account into your
name in the Direct Registration System. Such a transfer
means that you would hold your shares as “book‑entry”
securities and your ownership would be shown on our stock
transfer records and represented by a statement which
shows your holdings of shares of Stock.
You may request that Computershare sell all or a portion
of the shares of Stock (including any fractional interests)
credited to your Plan account at any time, whether or not
you want to close your Plan account.
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You will be charged a brokerage commission, as well as
any other applicable fees, if for any reason you have
Computershare sell shares of Stock held in your Plan account.
Any brokerage commission or fees will be at the rates
posted by Computershare from time to time. These rates
are available upon request from Computershare. A current
schedule of Computershare’s fees applicable to the Plan
can be found at computershare.com/walmart. The company
negotiated the amount of such fees with Computershare.
If you choose to sell your Stock, your Stock will be sold
pursuant to a market order. Although the Plan permits sales
of shares of Stock held in Plan accounts to be made through
batch orders and such sales have been made through batch
orders in the past, sales of shares of Stock under the Plan
are now made solely pursuant to market orders. As a result,
if you direct Computershare to sell any shares of Stock
credited to your Plan account, Computershare will sell
those shares in the open market at the then current best
available price. However, the price at which your order will
be executed is not guaranteed, and the last‑traded price for
the Stock prior to the execution of your order to sell your
shares of Stock is not necessarily the price at which your
order will be executed. From time to time, we repurchase
shares of Stock in the open market under a stock repurchase
program adopted by our Board of Directors. As a result, if
Computershare sells shares credited to your Plan account in
the open market, we could be the purchaser of such shares.
However, we will typically not know if any of the shares
of Stock we purchase in the open market are purchased
from you. Your shares of Stock will be sold as soon as your
request can reasonably be processed. Generally, market
orders are executed immediately after they are placed.
We expect that any sales of your shares of Stock will be
executed over the New York Stock Exchange (the “NYSE”),
but orders for those sales need not be executed over the
NYSE. If the NYSE is closed when your order is ready to
be processed, your sale transaction will be processed as
early as practicable on the next NYSE trading day. Orders
for the sale of shares of Stock under the Plan may be
executed by or through an affiliate of Computershare that
is registered with the SEC as a broker‑dealer under the
Securities Exchange Act of 1934. Sales of the Stock will be
made in U.S. dollars. If you are employed outside the U.S. by
a Participating Employer and if provided by Computershare
for your country, the proceeds from the sale may be
converted for a fee to another currency if you request it
when you request your Stock to be sold. If the proceeds
are converted to another currency, the exchange rate that
will be used is generally the exchange rate one business day
immediately after the day of the trade, but that may not be
practicable in all circumstances.
Termination of participation;
account closure
Once you become a participant in the Plan, you will remain
a participant until you elect to close your Plan account
and all Stock and sale proceeds credited to it have been
distributed out of your Plan account, or until all Stock
and sale proceeds have been distributed from your Plan
account after your employment with the company or one
of its affiliates has terminated.
If you terminate your payroll deduction authorization, or
your employment with the company and all its affiliates has
terminated, you may choose to continue your Plan account;
or you may close your Plan account if you specify this to
Computershare. Specifically:
• You may keep your Plan account open (without the
weekly or biweekly payroll deduction and your employer’s
matching contributions). If you keep your account open,
you may continue to make voluntary cash contributions
and no brokerage commissions will be charged on the
purchase of Stock. If you cease to be employed by the
company or one of its affiliates, an annual maintenance
fee will be charged to your account. Computershare has
the option to collect such maintenance fee either in the
form of quarterly installments, or in an annual lump sum
payment, which is due in the first quarter of each calendar
year and will be paid by means of the sale of an appropriate
number of shares or portion of a share of Stock by
Computershare. (If you are transferred to a company
affiliate that is not a Participating Employer, the company
may continue to pay the maintenance fee for you.)
• If you own at least one full share of Stock, you may close
your Plan account by moving your Stock into a “General
Shareholder” account maintained on your behalf by
Computershare. You may accomplish this move either by
receiving all full shares in certificate form with a check
for any fractional share ownership or by re‑depositing
the shares in the General Shareholder account, or
Computershare can move the shares electronically at your
request. You should contact Computershare for more
information about the fees associated with a General
Shareholder account.
• You may close your Plan account by having all shares
of Stock in your account sold and the proceeds paid to
you, or you can have certificates for full shares (and cash
proceeds of any fractional shares paid to you) delivered to
you instead. The proceeds of any sale of full or fractional
shares will be net of brokerage commissions, sales fees
and other applicable charges. Your account will be closed
automatically if you terminate employment and there are
no shares or fractional shares in your account.
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PROSPECTUS
If you die before your Plan account has been closed, your
Plan account will be distributed per the legal documentation
submitted to Computershare or to your estate, unless
you had previously arranged with Computershare to
have your stock held in a joint account. In the event you
have a joint account, the joint account holder may either
make arrangements with Computershare to move your
shares into a General Shareholder account maintained by
Computershare at his or her own expense or to have the
Stock (or proceeds from the sale thereof ) distributed, less
any applicable fees or commissions.
If you established a joint tenant account prior to April 1,
2018, you may contact Computershare at 800-438-6278
(hearing impaired: 800-952-9245) to remove a joint tenant
from your account.
Plan amendment and termination
The Plan has no set expiration date. The Board of
Directors of the company, the Committee or any other
duly appointed committee of the Board of Directors may
amend or terminate the Plan at any time. However, if
stockholder approval of an amendment is required under
law or the applicable rules of a national stock exchange, the
amendment will be subject to that approval. No amendment
or termination of the Plan will cause you to forfeit: (1) any
funds you have contributed to the Plan or matching funds
the company has contributed that have not yet been used
to purchase shares of Stock; (2) any shares (or fractional
shares) of the Stock credited to your Plan account; or (3) any
dividends or distributions declared with respect to the Stock
after you have made a contribution to the Plan but before
the effective date of the amendment or termination.
Tax information
The following summary of the U. S. income tax
consequences of the Plan is based on the Internal Revenue
Code and any regulations thereunder as in effect as of the
date of this Prospectus. The summary does not cover any
state or local income taxes or taxes in jurisdictions other
than the United States. You should consult your tax advisor
regarding individual tax consequences before purchasing
Stock under the Plan.
STOCK PURCHASES UNDER THE STOCK
PURCHASE PLAN
You have no federal income tax consequences when you
enroll in the Plan or when shares of Stock are purchased
for you under the Stock Purchase Plan either by payroll
deduction or voluntary contribution. The amount of your
payroll deductions and any voluntary contributions under
the Plan are not deductible for purposes of determining your
federal taxable income. The amount of your wages that you
have deducted under the Plan and the full value of company
matching contributions are ordinary income to you in the
calendar year of deduction or the contribution, as the case
may be, and will be reported on your pay stub and your W‑2.
The company deducts all applicable wage withholding and
other required taxes from your other compensation (by
increasing your payroll withholding and other tax deductions
for such purposes) with respect to the amount of your wages
deducted under the Plan and the matching contributions to
your Plan account, if any. The company is entitled to a tax
deduction for the amount of the matching contribution in
the same year as you realize the income.
OUTSTANDING PERFORMANCE AWARDS
UNDER THE OUTSTANDING PERFORMANCE
AWARD PROGRAM
Stock grants under the Outstanding Performance Award
Program are taxable as ordinary income in the calendar year
of the award, regardless of whether the Stock certificates
are given directly to you or the Stock is awarded to your
Plan account. Your ordinary income will be the market value
of a share of Stock on the date the award is granted, times
the number of shares of Stock granted. The market value
of any Stock awarded will be reported to you on your W‑2.
The company will deduct applicable wage withholding and
other required taxes from your other compensation (by
increasing your payroll deduction for such purposes). The
company is entitled to a tax deduction in the same amount
and in the same year as you realize the ordinary income.
STOCK SALES OR CERTIFICATE DISTRIBUTIONS
You will not recognize any taxable income when you request
to have certificates delivered to you for some or all of the
shares of Stock held in your Plan account. However, when
you sell or otherwise dispose of your shares of Stock—
whether through Computershare or later after you have
received your Stock certificates—the difference between
the fair market value of the Stock at the time of sale and
the fair market value of the Stock on the date you acquired
it will be taxed as a capital gain or loss. The holding period
to determine whether the capital gain or loss is long‑term
or short‑term will begin on the date you acquire the Stock
(i.e., the date the Stock is credited to your Plan account).
The company will have no deduction as a result of your
disposition of shares of Stock and will not be liable for the
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
PROSPECTUS
payment of any income or other taxes payable by you on
any gain you may realize on the sale of the shares of Stock
or imposed on or in connection with the sale transaction.
Available information
To obtain additional information about the Plan or
its administrators, please call People Services at
800-421-1362. You can also write to:
Walmart People Services
Walmart Inc.
508 SW 8th Street
Bentonville, Arkansas 72716-0295
Computershare may be contacted by calling
800-438-6278 (800 GET-MART) (hearing impaired:
800-952-9245), online at computershare.com/walmart, or
by writing to the following address for all correspondence,
including transactions, Stock certificate requests,
Stock powers, voluntary purchases and any customer
service inquiries:
Computershare
Attn: Walmart ASPP
P.O. Box 505042
Louisville, Kentucky 40233
Electronic delivery of prospectuses
and other documents
To help reduce costs of operating the Plan and to help
with our sustainability efforts, we ask you to allow us
to deliver prospectuses and other documents related
to the Plan electronically and that you access the
prospectuses and documents we provide to participants
in the Plan over One.Walmart.com. Your enrollment in
the Plan will constitute your consent to receive or access
communications from us about the Plan and prospectuses
relating to the purchase of shares of Stock under the
Plan electronically through access on One.Walmart.com,
unless you affirmatively elect to receive paper copies of
such communications. At any time after enrollment you
may revoke that consent by sending a written revocation
of the consent to receive Plan documents electronically
to the Benefits Department at the address appearing
below. In addition, you may request a paper copy of
the then current prospectus relating to purchases of
shares of Stock under the Plan and of our most recent
Annual Report on Form 10‑K by writing the Benefits
Department and those documents will be provided to
you free of charge.
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Documents incorporated
by reference
The following documents filed by the company with the
Securities and Exchange Commission (the “Commission”)
(File No. 1‑6991) are hereby incorporated by reference in
and made a part of this Prospectus:
• The company’s Annual Report on Form 10‑K for the fiscal
year ended January 31, 2021;
• The company’s Quarterly Reports on Form 10‑Q for the
fiscal quarter ended April 30, 2021;
• The company’s Current Reports on Form 8‑K filed with
the Commission on June 4, 2021;
• The company’s definitive Proxy Statement for the 2021
Annual Shareholders’ Meeting, filed with the Commission
on April 22, 2021; and
• Exhibit 99.1 to the Company’s Registration Statement on
Form S‑8 (File No. 333‑214060)
All documents filed by the company pursuant to Sections
13(a), 13(c), 14 and 15(d) of the Securities Exchange Act
of 1934 (the “Exchange Act”) on or after the date of this
Prospectus shall be deemed to be incorporated by reference
in this Prospectus and to be a part hereof from the date of
filing of such documents, except for information furnished to
the Commission that is not deemed to be “filed” for purposes
of the Exchange Act (such documents, and the documents
listed above, being hereinafter referred to as “Incorporated
Documents”). Any statement contained in an Incorporated
Document shall be deemed to be modified or superseded
for purposes of this Prospectus to the extent that a
statement contained herein or in any other subsequently
filed Incorporated Document modifies or supersedes such
statement. Any such statement so modified or superseded
shall not be deemed, except as so modified or superseded,
to constitute a part of the Section 10(a) prospectus of the
company relating to purchases under the Plan of the shares
of Stock described on the cover page of this Prospectus. This
document and the documents incorporated by reference
herein constitute such Section 10(a) prospectus.
These documents and the company’s latest Annual Report
to Stockholders and any other documents required to be
delivered to you under Rule 428(b) under the Securities Act
of 1933, as amended, are available to you without charge
upon written or oral request. Please direct your requests
for documents to:
Walmart Inc.
Benefits Department
508 SW 8th Street
Bentonville, Arkansas 72716-0295
Or you may call People Services at 800-421-1362.
The Walmart
401(k) Plan
Walmart 401(k) Plan eligibility
Enrolling in the Plan
Your Walmart 401(k) Plan accounts
Making a rollover from a previous employer’s plan or IRA
Repaying certain distributions to the Plan
Making contributions to your account
Making an In‑Plan Roth Conversion
Walmart’s contributions to your Company Match Account
Investing your account
More about owning Walmart stock
Account balances and statements
Receiving a payout while working for Walmart
If you die: your designated beneficiary
If you get divorced
If you leave Walmart
If you leave and are rehired by Walmart
The income tax consequences of a payout
Filing a Walmart 401(k) Plan claim
Administrative information
Special tax notice addendum
Special tax notice addendum: Roth contributions
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The legal name of the Plan is the Walmart 401(k) Plan. This document is being provided solely by your
employer. No affiliate of Bank of America Corporation has reviewed or participated in the creation of the
information contained herein.
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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Online
Go to One.Walmart.com
or the Plan’s website at
benefits.ml.com
Go to benefits.ml.com
Other Resources
Call the Customer
Service Center at
888-968-4015
Call the Customer
Service Center at
888-968-4015
The Walmart 401(k) Plan
RESOURCES
Find What You Need
Enroll in or change your pretax contribution and/or your catch‑up
contribution
• Enroll in or change your pretax, Roth, and/or your catch‑up contributions
• Set‑up periodic automatic increases to your contribution rate
• Starting December 20, 2021, request an In‑Plan Roth Conversion
• Request a rollover packet to make a rollover contribution
• Get a fee disclosure sheet
• Get information about your Plan accounts
• Get a copy of your quarterly statement
• Request a hardship withdrawal or a withdrawal after you reach age 59½
• Starting February 1, 2022, request a withdrawal to assist with birth or
adoption expenses
• Change your investment fund choices
• Request a payout when you leave Walmart
• Get information about your Plan investment options
• Request a withdrawal of your rollover contributions
• Request a loan from your Plan account
Designate a beneficiary
Go to One.Walmart.com
What you need to know about the Walmart 401(k) Plan
• You are eligible to make your own contributions to the Plan as soon as administratively feasible after your hire date.
You can contribute from 1% to 50% of your eligible pay each pay period.
• You can elect to make pretax salary deferral contributions and/or Roth salary deferral contributions. Pretax salary deferral
contributions (and earnings thereon) are not subject to current federal income tax and, in most cases, state or local taxes,
until distributed from the Plan. Roth salary deferral contributions are made on an after‑tax basis, but the contributions and,
in most cases, the earnings thereon are not subject to federal income tax when distributed to you (as long as the distribution
meets certain requirements).
• Beginning December 20, 2021, you are also eligible to convert pretax contributions to after‑tax Roth contributions
by requesting an In‑Plan Roth Conversion.
• If you are credited with at least 1,000 hours of service in your first year and contribute to your account, you begin
receiving matching contributions on the first day of the calendar month following your first anniversary of employment.
• After you become eligible for matching contributions, Walmart matches each dollar you contribute, up to 6% of your
eligible annual pay. (Contributions you make before you become eligible for matching contributions are not matched.)
• You are always 100% vested in the money you contribute and the money Walmart contributes to your Company Match Account.
• You choose how to invest all contributions to your Plan account.
• If you do not specify how your contributions will be invested, they are automatically invested in the Plan’s default
investment option, the myRetirement Funds.
• The Plan accepts rollover contributions from other eligible retirement plans. You can withdraw your rollover contributions
at any time.
• You may request a loan from your Plan account, subject to Plan rules.
• Starting February 1, 2022, you can request a withdrawal of up to $5,000 in connection with the birth or adoption of your child.
This is a summary of benefits offered under the Plan as of October 1, 2021 (unless otherwise noted). Should any questions arise
about the nature and extent of your benefits, the formal language of the Plan document, not the informal wording of this
summary, will govern.
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Walmart 401(k) Plan eligibility
ASSOCIATES WHO ARE ELIGIBLE TO
PARTICIPATE IN THE PLAN
Plan year, you will begin receiving matching contributions on
February 1, 2022 with respect to any contributions you make
to the Plan on or after that date.
All associates of Walmart Inc. or a participating subsidiary
are eligible to participate in the Plan, except:
• Leased employees; nonresident aliens with no income from
U.S. sources; independent contractors or consultants
HOW HOURS OF SERVICE ARE CREDITED
UNDER THE PLAN
If you are an hourly associate, the hours counted toward the
1,000‑hour requirement are credited as follows:
• Anyone not treated as an employee of Walmart or its
• Hours, including overtime hours, you work for Walmart or
participating subsidiaries
any subsidiary are counted.
• Associates covered by a collective bargaining agreement,
to the extent that the agreement does not provide for
participation in this Plan, and
• Associates represented by a collective bargaining
representative after Walmart has negotiated in good faith to
impasse with the representative on the question of benefits.
For purposes of this Summary Plan Description, all
participating subsidiaries are referred to as “Walmart.”
WHEN PARTICIPATION BEGINS
For purposes of your contributions. If you are an eligible
associate, you may begin contributing to the Plan as soon as
administratively feasible after your date of hire is entered
into the payroll system. See Enrolling in the Plan later in this
summary for details about the enrollment process.
For purposes of matching contributions. If you are an eligible
associate, you will begin receiving matching contributions
on the first day of the calendar month following your first
anniversary of employment with Walmart if you are credited
with at least 1,000 hours of service during your first year and
are contributing your own contributions (pretax contributions
and/or Roth contributions) to the Plan. (If you are classified as
a highly compensated employee, you must also have attained
age 21.) (Matching contributions are not made with respect
to contributions you make before you become eligible for
matching contributions.) For example, if your date of hire was
December 15, 2020 and you are credited with 1,095 hours
by December 15, 2021 (your first anniversary), then you will
begin receiving matching contributions on January 1, 2022,
with respect to any contributions you make to the Plan on or
after that date.
If you are not credited with 1,000 hours of service during
your first year, your eligibility for the matching contributions
will be determined on hours worked during the Plan year,
which runs from February 1 to January 31. You will be eligible
to receive matching contributions on any contributions you
make to the Plan on or after the February 1 that follows the
Plan year in which you are credited with at least 1,000 hours
of service. For example, if your date of hire is December
15, 2020, and you are credited with only 595 hours by
December 15, 2021 (your first anniversary), but you work
1,095 hours during the February 1, 2021–January 31, 2022
• Hours for which you receive paid leave or personal time off
are also counted.
• When a payroll period overlaps two Plan years, hours
are credited toward the Plan year in which they are
actually worked.
If you are a salaried associate or truck driver, the hours
counted toward the 1,000‑hour requirement are credited
as follows:
• You are credited with 190 hours per month for each month
in which you work at least one hour for Walmart or a
subsidiary.
• In general, you must work at least six months of the Plan
year to have 1,000 hours credited for the year. (Vacation
paid to you in cash after you leave Walmart does not give
you additional service for this purpose.)
If you become an associate of Walmart or any subsidiary as
the result of the acquisition of your prior employer, special
service crediting rules may apply to you.
Under the Uniformed Services Employment and
Reemployment Rights Act of 1994 (USERRA), veterans
who return to Walmart or a subsidiary after a qualifying
deployment may be eligible to have their qualified military
service considered toward their hours of service under the
Plan. Call People Services at 800-421-1362 for more details.
Enrolling in the Plan
Shortly after you become eligible to contribute to the Plan,
(i.e., shortly after your date of hire), you will receive an
enrollment packet at your home address on file. This packet
tells you how you can make contributions from your pay
into your Pretax Account and/or Roth Account and explains
how you can direct the investment of your Plan funds
by choosing from among a menu of investment options
with varying investment objectives and associated risks.
Because the Plan is intended to be an important source for
your financial security at retirement, you should read all
information pertaining to the Plan carefully.
Once you satisfy the eligibility requirements for receiving
matching contributions, Walmart will match all of your
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
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subsequent contributions dollar‑for‑dollar up to 6%
of eligible annual pay, as explained in the Walmart’s
contributions to your Company Match Account section.
To begin contributing to the Plan, enroll online at
One.Walmart.com or benefits.ml.com. You can also call the
Customer Service Center at 888-968-4015. Note, however,
that if you wish to make Roth contributions to the Plan, you
must enroll at benefits.ml.com. You can enroll at any time
after you become eligible.
When you enroll, you can choose:
• The percentage of your pay that you want to contribute
on a per‑pay‑period basis and whether your contributions
will be pretax contributions or Roth contributions or a
combination of both (see Making contributions to your
account later in this summary), and
• How to invest your accounts among the Plan’s investment
options. The Plan’s investment options and procedures are
described in your enrollment packet.
After you enroll, a confirmation notice will be mailed
to your home address, or, if you have chosen electronic
delivery of Plan materials, you will receive an email
notification when the confirmation is available. The
confirmation will show the percentage of your pay that you
have chosen to contribute from each check, whether you
elected to make pretax contributions or Roth contributions,
or both, and the investment options you have elected.
Review the confirmation to make sure your enrollment
information is correct.
Your contributions to the Plan will start as soon as
administratively feasible, normally within two pay periods
after you enroll. No contributions are taken from your
pay before you become an eligible participant in the Plan.
Only participants who contribute their own funds to the
Plan will have those contributions matched by Walmart,
subject to eligibility requirements outlined in the Walmart’s
contributions to your Company Match Account section.
It is your responsibility to review your paychecks to confirm
that your election is implemented correctly. If you believe
your election has not been implemented correctly, notify
the Customer Service Center at 888-968-4015 in a
timely manner so that corrective steps can be taken. Your
notification will not be considered timely if it is made more
than three months after the date you make your election.
Your Walmart 401(k) Plan accounts
The Walmart 401(k) Plan consists of several accounts. You
will have some or all of the following accounts:
• Pretax Account: This account holds your pretax
contributions to the Plan (including your catch‑up
contributions, if any), as adjusted for earnings or losses on
those contributions.
• Roth Account: This account holds your Roth contributions
to the Plan (including your Roth catch‑up contributions,
if any), as adjusted for earnings or losses on those
contributions. The Roth Account will also hold any amounts
you elected to convert in an In‑Plan Roth Conversion, to
the extent those amounts were not otherwise distributable
under the Plan at the time of conversion, as adjusted for
earnings or losses.
• Company Match Account: This account holds Walmart’s
matching contributions, as adjusted for earnings or losses
on those contributions.
• Pretax Rollover Account: This account holds any
contributions that you rolled over to this Plan from
another eligible retirement plan, as adjusted for earnings
or losses on those contributions.
• Roth Rollover Account: This account holds any amounts
you rolled over to this Plan from your designated Roth
salary deferral account in another eligible retirement plan,
as well as any amounts that you elected to convert in an
In‑Plan Roth Conversion, to the extent those amounts
were otherwise distributable under the Plan at the time of
conversion, as adjusted for earnings or losses.
• Company Funded 401(k) Account: This account holds the
discretionary Walmart contributions to the Plan made for
Plan years ended on or before January 31, 2011, as adjusted
for earnings or losses on those contributions.
• Company Funded Profit Sharing Account: This account
holds the discretionary Walmart contributions to the Plan
made for Plan years ended on or before January 31, 2011, as
adjusted for earnings or losses on those contributions.
Differences between these accounts are discussed in more
detail throughout this summary.
Note that if you become an associate of Walmart or any
subsidiary as the result of the acquisition of your prior
employer, and you participated in your prior employer’s
401(k) plan, you may have other accounts in this Plan that
hold amounts you contributed to your prior employer’s
plan. If you think this applies to you, you can obtain more
information on your other accounts by calling the Customer
Service Center at 888-968-4015.
Making a rollover from a previous
employer’s plan or IRA
When you come to work for Walmart, you may have funds
owed to you from a previous employer’s retirement plan
(including a 401(k) plan, a profit‑sharing plan, a 403(b)
plan of a tax‑exempt employer or a 457(b) plan of a
governmental employer). If so, you may be able to roll over
that money to this Plan. You may also roll over pretax funds
you have in an individual retirement account (IRA). You may
generally roll over only pretax funds, but you may directly
roll into the Plan amounts from a designated Roth salary
deferral account in another qualified retirement plan. If you
roll over funds to this Plan, keep these points in mind:
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• Once you roll funds into the Walmart 401(k) Plan, those
funds are subject to the rules of this Plan, including payout
rules, and not the rules of your former employer’s plan or
your IRA
In addition, you can choose whether your contributions
will be “pretax contributions” and/or “Roth contributions.”
Together, these contributions are called your “401(k)
contributions” in this summary.
• Your rollover contribution will be placed in your Rollover
Account or your Roth Rollover Account, as applicable, and
will be 100% vested, and
• You may withdraw all or any portion of your rollover
contributions at any time.
If you’re interested in making a rollover contribution to the
Plan, contact the Customer Service Center at 888-968-4015
or visit benefits.ml.com to obtain a rollover packet.
Repaying certain distributions to
the Plan
If you previously received one of the following types of
distributions from the Plan, you may repay all or any part of
those distributions to the Plan and they will be considered
part of your Rollover Account, subject to the rules above:
• If you were a “qualified individual” and received a CARES
Act distribution from the Plan between April 20, 2020 and
December 31, 2020 (or from another eligible retirement
plan between January 1, 2020 and December 31, 2020), you
may recontribute all or part of that distribution into this
Plan as long as you are otherwise eligible to make a rollover
to the Plan and you do so within three years of the date you
received the distribution. You generally were a “qualified
individual” if you or a family member were diagnosed with
COVID‑19 or experienced financial consequences as the
result of COVID‑19’s impact on your work.
• If you receive a qualified birth or adoption distribution
from this Plan after February 1, 2022 and you are otherwise
eligible to make a rollover to the Plan, you can recontribute
all or part of that distribution to the Plan at any time.
If you’re interested in recontributing all or part of your
prior distribution to the Plan, contact the Customer Service
Center at 888-968-4015 or visit benefits.ml.com.
Making contributions to your account
After you become a participant in the Plan, you may
generally choose to contribute from 1% up to 50% of
each paycheck to your Pretax Account and/or your Roth
Account. Your contributions (including both pretax
contributions and Roth contributions) in any calendar year,
however, may not exceed a limit set by the IRS. For 2022,
the limit is $20,500. This amount will be increased from time
to time by the IRS.
The IRS also limits the amount of compensation that can be
taken into account under the Plan for any participant for
a Plan year. For the Plan year ending January 31, 2023, this
limit is $305,000.
• Pretax contributions are deducted from your pay before
federal income taxes are withheld. This means that you
don’t pay federal income taxes on amounts you contribute
to the Plan. Earnings on these contributions accumulate
tax‑free and are not taxed until your Pretax Account is
actually distributed to you from the Plan (or until you elect
an In‑Plan Roth Conversion). You may also save on state
and local taxes as well, depending on your location. Please
note that your contributions are subject to Social Security
taxes in the year the amount is deducted from your pay.
Distributions from the Plan, however, are not subject to
Social Security taxes.
• Roth contributions are deducted from your pay after
federal income taxes are withheld. This means that you pay
federal and state income taxes, and also Social Security
taxes, on amounts you contribute to the Plan in the year the
amount is deducted from your pay. Roth contributions, and
earnings on those contributions, are normally not subject
to federal and state income tax when your Roth Account is
distributed to you from the Plan. In order for the earnings
to be tax‑free, the distribution must be a “qualified”
distribution, as explained later. (Note that income
limitations applicable to Roth IRAs are not applicable to
Roth contributions to the Plan. You may choose to make
Roth contributions regardless of your income.)
In addition, if you make contributions to the Plan, you
may be eligible for a “Saver’s Credit.” If you are a married
taxpayer who files a joint tax return and you have a modified
adjusted gross income (MAGI) of $68,000 or less (for 2022)
or a single taxpayer with $34,000 or less (for 2022) in MAGI
on your tax return, you are eligible for this tax credit, which
can reduce your taxes. For more details, your tax preparer
may refer to IRS Announcement 2001‑106.
HOW YOUR 401(K) CONTRIBUTION
IS DETERMINED
The percentage of pay you elect to contribute to the Plan is
applied to the following types of pay:
• Regular salary or wages, including bonuses and any
pretax dollars you use for your pretax contributions or
to purchase benefits available under the Walmart Inc.
Associates’ Health and Welfare Plan
• Overtime, paid time off (used and paid out), bereavement,
jury duty and premium pay
• Most incentive plan payments
• Holiday bonuses
• Special recognition awards, such as the Outstanding
Performance Award
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• Differential wage payments you receive from Walmart
while you are on a qualified military leave. This means that
the contribution you have in effect when you go on the
leave will continue to be applied to your differential wage
payments while you are on the leave unless you change
your election, and
• Transition pay designated as relating to a WARN Act event.
The percentage of pay you elect to contribute to the Plan
will not be applied to the following types of pay:
• The 15% Walmart match on the Associate Stock
Purchase Plan
• Reimbursement for expenses like relocation
• Approved disability pay
• Equity income, including income from stock options or
restricted stock rights, or
• Upon your termination of employment, a final paycheck
paid prior to the end of a normal pay cycle (unless it is
administratively practicable to withhold your contribution
from that paycheck).
CHANGING YOUR 401(K)
CONTRIBUTION AMOUNT
You can increase, decrease, stop, or begin your contributions
at any time by logging on to One.Walmart.com or
benefits.ml.com. You may also call the Customer Service
Center at 888-968-4015. Your change will be effective
as soon as administratively feasible, normally within two
pay periods. If you change your contribution amount, a
confirmation notice will be sent to your home address or, if
you have chosen electronic delivery of Plan documents, you
will receive an email notification when the confirmation is
available. It is your responsibility to review your paychecks to
confirm that your election is implemented correctly. If you
believe your election has not been implemented correctly,
notify the Customer Service Center at 888-968-4015 in
a timely manner, so that corrective steps can be taken.
Your notification will not be considered timely if it is more
than three months after the date you make your election.
If you do not notify the Customer Service Center in a
timely manner, the amount that is being withheld from your
paycheck will be treated as your deferral election.
IF YOU ARE AGE 50 OR OLDER
(CATCH-UP CONTRIBUTIONS)
If you are age 50 or older (or will be age 50 by the end
of the applicable calendar year) and you are contributing
up to the Plan or legal limits, you are allowed to make
additional contributions. These are called “catch‑up
contributions” and are made by payroll deduction just like
your other contributions. You can choose whether your
catch‑up contributions will be either pretax contributions
or Roth contributions, or both. For 2022, your catch‑up
contributions may be any amount up to the lesser of
$6,500 or 75% of your eligible annual pay. The dollar
amount may be adjusted from time to time by the IRS.
Your catch‑up contributions will be credited to your Pretax
Account or your Roth Account, depending on which type
of contributions you elect to make. Remember, Roth
contributions can be made only at benefits.ml.com.
For example, if you elect to contribute the maximum
amount in the 2022 calendar year, which is the lesser of
$20,500 or the maximum percentage of your eligible annual
pay allowed under the Plan, you could elect to contribute up
to an additional $6,500 during the 2022 calendar year. If you
are interested in making catch‑up contributions, you can
enroll online at One.Walmart.com or benefits.ml.com, or by
calling the Customer Service Center at 888-968-4015.
CONTRIBUTING TO MORE THAN ONE PLAN
DURING THE YEAR
The maximum total amount you can contribute (including
pretax contributions and Roth contributions) to this Plan
and to any other employer plan (including 403(b) annuity
plans, simplified employee pensions or other 401(k) plans)
is $20,500 for the 2022 calendar year, or $27,000 if you
are eligible for catch‑up contributions. This amount may be
increased from time to time by the IRS. If you contribute to
more than one plan during the year, it is your responsibility
to determine if you have exceeded the legal limit.
If your total contributions go over the legal limit for a
calendar year, you should request that the excess amount be
refunded to you. The excess amount (except as noted below
with respect to Roth contributions) must be included in your
income for the year deferred and will be taxed. Earnings on
the excess amount are taxable in the year refunded to you. In
addition, if the excess amount is not refunded to you by April
15 following the year the amount was deferred, you will be
taxed a second time when the excess amount is distributed
to you. To request that excess contributions be returned to
you from this Plan, contact the Customer Service Center at
888-968-4015 no later than April 1 following the calendar
year in which the excess contributions were made. The
Administrator will establish procedures for determining
whether your pretax contributions or Roth contributions
will be returned to you, if you contributed both types of
contributions during the calendar year. To the extent excess
amounts are distributed from your Roth contributions, the
Roth contributions will not be taxable to you, but related
earnings that are distributed will be taxable to you. Any
matching contributions related to refunded contributions
will be forfeited.
IF YOU HAVE QUALIFIED MILITARY SERVICE
If you miss work because of qualified military service, you
may be entitled under the Uniformed Services Employment
and Reemployment Rights Act of 1994 (USERRA) to make
up contributions you miss during your military service
(that is, to make contributions equal to the amount you
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would have been eligible to make if you were working for
Walmart). For more information, contact the Customer
Service Center at 888-968-4015.
Making an In-Plan Roth Conversion
Beginning December 20, 2021, you can choose to convert
all or any part of the vested contributions in your account
(other than Roth contributions and related earnings, and
funds that are part of an outstanding loan balance) to
Roth contributions through an “In‑Plan Roth Conversion.”
The contributions you choose to convert, along with any
earnings on those contributions through the date of the
conversion, will be subject to applicable federal, state,
and local taxes in the year of conversion. No taxes will be
withheld at the time of conversion, however, so it will be up
to you to ensure that you can pay the related taxes when
due. Accordingly you may want to increase your payroll
withholdings or make estimated tax payments. The amount
converted is not subject to a 10% penalty. Once converted,
the funds may not be converted back to pretax funds.
The rules applicable to your funds after conversion
differ depending on whether the funds were eligible for
distribution from the Plan at the time of the conversion.
purpose is the same as outlined above for determining
your 401(k) contributions to the Plan, but does not include
amounts paid to you before you become eligible to receive
matching contributions.
NOTE: The matching contribution limit is applied on a Plan
year basis (February 1–January 31). Because the dollar limit
on your 401(k) contributions ($20,500 for 2022) is applied
on a calendar year basis, it is important that you consider
the timing of your 401(k) contributions to ensure that
you receive the full matching contribution. For instance,
if you contribute the full $20,500 in 401(k) contributions
in January of 2022, you may not receive a matching
contribution on those amounts if you have already received
the maximum matching contribution limit earlier in the Plan
year ended January 31, 2022.
As previously noted, if you miss work because of qualified
military service, you may be entitled under USERRA to
make up 401(k) contributions that you missed during your
military service. If you do make up any 401(k) contributions,
Walmart is required to make up matching contributions you
would have received with respect to those contributions.
If you think this rule applies to you, contact People Services
at 800-421-1362.
• If the funds you convert were otherwise eligible for
VESTING IN YOUR COMPANY MATCH ACCOUNT
distribution (for instance, you are age 59½) and eligible for
rollover, then the funds will be treated as though they were
distributed from the Plan and then rolled back into the
Plan. This means they will be credited to your Roth Rollover
Account and may be withdrawn at any time.
• If the funds you convert were not eligible for distribution,
they will be credited to your Roth Account and will remain
subject to the same distribution rules after the conversion
as they were before the conversion. For instance, if you
elect to convert your pretax salary deferral contributions,
those funds generally will not be eligible for distribution
until you reach age 59½, incur a financial hardship, or
terminate employment.
Walmart’s contributions to your
Company Match Account
Once you are eligible to receive matching contributions,
Walmart will make matching contributions to your
Company Match Account equal to 100% of your subsequent
contributions (including pretax, Roth, and catch‑up
contributions) for the Plan year, up to 6% of your eligible
annual pay for the Plan year. Matching contributions are
not made with respect to contributions you make before
you become eligible for matching contributions. After you
become eligible for matching contributions, the company
matching contribution will be made to your Company Match
Account each pay period until you reach the full amount
of the company matching contribution for which you are
eligible for that Plan year. Your eligible annual pay for this
You are always 100% vested in Walmart’s matching
contributions to your Company Match Account.
VESTING IN YOUR COMPANY FUNDED PROFIT
SHARING ACCOUNT
If you have a Company Funded Profit Sharing Account (see
Your Walmart 401(k) Plan accounts earlier in this summary),
the vested percentage of your Company Funded Profit
Sharing Account is the portion that you are entitled to
receive if you leave Walmart. Your account statements show
your vested percentage.
You become vested in your Company Funded Profit Sharing
Account (other than rollovers in that account, which are
always 100% vested) depending on your years of service
with Walmart as follows:
PROFIT SHARING VESTING SCHEDULE*
Years of service
Vested percentage
Less than two
2
3
4
5
6 or more
0%
20%
40%
60%
80%
100%
* Applies to participants actively employed on or after
January 31, 2008.
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NOTE: If you terminated employment before February 1,
2007, your payout was based on the prior vesting schedule
and not the vesting schedule shown above.
Alternative (QDIA) notice and the Investment Guide. These
documents can be obtained by going to benefits.ml.com or
by calling the Customer Service Center at 888-968-4015.
A year of service for this purpose is a Plan year (February 1
–January 31) in which you are credited with at least 1,000
hours of service under the hours of service rules (see
How hours of service are credited under the Plan earlier
in this summary). If you are credited with less than 1,000
hours in a Plan year, your vesting does not increase for that
year. (Note that years of service for this purpose are not
determined by your anniversary date.)
If you leave Walmart because of retirement (at age 65
or older) or death, your Company Funded Profit Sharing
Account will be 100% vested, regardless of your years of
service. Your Company Funded Profit Sharing Account will
also be 100% vested if the Plan is ever terminated.
VESTING IN YOUR COMPANY FUNDED
401(K) ACCOUNT
You are always 100% vested in Walmart’s contributions to
your Company Funded 401(k) Account.
Investing your account
YOUR INVESTMENT OPTIONS
You decide how your accounts will be invested. You can choose:
• The myRetirement Funds. The myRetirement Funds are a
series of customized investment options created solely for
Plan participants by the Benefits Investment Committee,
and are commonly known as “target retirement date”
funds. The myRetirement Funds are diversified investment
options that automatically change their asset allocation
over time to become more conservative as you get closer
to retirement. This is done by shifting the amount of
money invested in more aggressive investments, such as
stocks, and allocating those amounts to more conservative
investments, such as bonds, as you near retirement.
• From among a menu of investment options made available
under the Plan. Note that Walmart stock is an investment
option only for your Company Funded Profit Sharing
Account. Walmart stock is not available for investment
through any of your other Plan accounts (although to the
extent these other accounts hold Walmart stock, you may
always sell such shares, but no future purchases of Walmart
stock are allowed).
You may choose one of the investment options or you may
spread your money among the various investment options.
The investment gains or losses on your accounts depend on
the performance of the investments you choose.
Because the Company Funded Profit Sharing Account
is an Employee Stock Ownership Plan, all or a significant
portion of Walmart’s profit‑sharing contribution was
invested in Walmart stock for Plan years ending prior to
January 31, 2006. If you were a participant in the Plan
prior to that date, you may have Walmart stock in your
Company Funded Profit Sharing Account. For Plan years
ending January 31, 2007 or later, Walmart’s profit‑sharing
contribution was not invested in Walmart stock.
A description of all investment options, including the
myRetirement Funds, is included in the enrollment packet
you receive when you are eligible to enroll. You also may
obtain additional information for each investment option by
reviewing the Annual Participant Fee Disclosure Notice and
Investment Guide. You may obtain these documents free of
charge by accessing your account online at benefits.ml.com
or by calling the Customer Service Center at 888-968-4015.
Please note that this Plan is intended to be an “ERISA
Section 404(c) plan.” This means that you assume all
investment risks connected with the investment options you
choose in the Plan, or in which your funds are invested if you
fail to make investment selections, including the increase
or decrease in market value. Walmart Inc., the Benefits
Investment Committee, and the trustee are not responsible
for losses to your accounts which are the direct and
necessary result of investment decisions you make or, if you
fail to make an affirmative investment decision, as a result
of your accounts being invested in a default fund.
If you have a Company Funded Profit Sharing Account (see
Your Walmart 401(k) Plan accounts earlier in this summary)
and you choose to invest some or all of your Company
Funded Profit Sharing Account in Walmart stock or retain
Walmart stock in your other accounts, be aware that since
this option is a single stock investment, it generally carries
more risk than the options offered through the Plan.
HOW TO OBTAIN MORE INVESTMENT
INFORMATION
It is also important to periodically review your investment
portfolio, your investment objectives, and the investment
options under the Plan to help ensure that your investments
are in line with your objectives and your risk tolerance.
For more sources of information on individual investing
and diversification, visit the website of the Department
of Labor’s Employee Benefits Security Administration
at www.dol.gov/agencies/ebsa and type “investing and
diversification” in the search field.
If you do not make an investment choice for current
contributions to your account, they will be invested in one
of the myRetirement Funds based on your age. For more
information, refer to the Qualified Default Investment
You may obtain more specific information regarding your
investment rights and investment options under the Plan at
benefits.ml.com or by calling the Customer Service Center
at 888-968-4015.
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CHANGING YOUR INVESTMENT CHOICES
More about owning Walmart stock
You can change your investment choices at any time online
at benefits.ml.com or by calling the Customer Service
Center at 888-968-4015. If you make an investment change,
a confirmation notice will be sent to your home address or
you will receive an email notification when the confirmation
is available if you have chosen electronic delivery of your
Plan materials. It is your responsibility to make sure your
change is made. If you do not receive a confirmation notice
or you do not see that your change has been applied, contact
the Customer Service Center at 888-968-4015.
If you call the Customer Service Center prior to 3:00 p.m.
Eastern time, your investment change generally will be
processed on the day you call. Depending on the investment
change, there may be up to a three‑day settlement period
before your funds are invested in your new election.
DIVERSIFICATION
To help you diversify your retirement savings, the Plan offers
a variety of investment options with different levels of risk
and potential for increase in value. To “diversify” means that
you spread your assets among different types of investments.
To help achieve long‑term retirement security, you should
give careful consideration to the benefits of a well‑balanced
and diversified investment portfolio. This strategy can help
reduce risk and may provide consistent returns because a
decline in the value of one investment may potentially be
offset by an increase in the value of another. If you invest
more than 20% of your retirement savings in any one stock,
such as Walmart stock, or any one industry, your savings may
not be properly diversified. Although diversification cannot
ensure a profit or protect against loss, it can be an effective
strategy to help you manage investment risk.
When deciding how to invest your retirement savings, you
should take into account all of your assets, including any
retirement savings outside of the Plan. For example, you
may own Walmart stock through other means. No single
approach is right for everyone because, among other
factors, individuals have different financial goals, different
time horizons for meeting their goals, and different
tolerances for risk. Keep in mind your rights to diversify
your Plan account and carefully consider how you choose
to invest your Plan account. For information about your
right to diversify your account and all of the investment
options available under the Plan, access your account online
at benefits.ml.com or call the Customer Service Center at
888-968-4015. It is also important to periodically review
your investment portfolio, your investment objectives, and
the investment options under the Plan to help ensure that
your investments remain appropriate for your retirement
goals and your tolerance for investment risk. For more
sources on individual investing and diversification, visit the
website of the Department of Labor’s Employee Benefits
Security Administration at www.dol.gov/agencies/ebsa and
type “investing and diversification” in the search field.
VOTING
If any of your account is invested in Walmart stock through
the Plan, each year you will receive all of the materials
generally distributed to the shareholders of Walmart,
including an instruction card telling the trustee how you
would like the shares in your Plan account to be voted.
The materials are mailed to your home address or sent
electronically, based on your online elections.
You can instruct the trustee, through the company’s
transfer agent, to vote Walmart stock held in your Plan
accounts. This usually occurs in May of each year. Your
instructions to the transfer agent and the trustee are kept
confidential at all times. You send your voting instructions
directly to the transfer agent, who compiles the votes
and notifies the Benefits Investment Committee of the
total votes cast. The Benefits Investment Committee then
notifies the Plan trustee of the total votes to be cast.
If you do not provide instruction to the trustee on how
you would like your shares voted, the Benefits Investment
Committee will vote those shares at its discretion. If neither
you nor the Benefits Investment Committee exercise voting
rights, the trustee or an independent fiduciary appointed by
the trustee may vote the unvoted shares.
CONFIDENTIALITY
Procedures have been designed to protect the confidentiality
of your rights with respect to shares of Walmart stock held
under the Plan, including the right to purchase, sell, hold,
or vote on proxy matters. For example, procedures with
the Company’s transfer agent for Walmart stock have been
implemented that prevent Walmart Inc. and the Benefits
Investment Committee from finding out how any individual
participant or beneficiary voted (except as necessary to
comply with securities laws) and from having access to your
individual proxy cards or proxy card shareholder comments.
In addition, access to information about your decisions to
buy, sell, or hold Walmart stock generally is limited to those
assisting in the administration of the Plan. The Benefits
Investment Committee is responsible for ensuring that these
procedures are sufficient to protect the confidentiality of
this information and that the procedures are being followed.
If the Benefits Investment Committee determines that a
situation has potential for undue influence by the Walmart
with respect to your rights as shareholder (through your
Plan Account), the Benefits Investment Committee will
appoint an independent party to perform activities that are
necessary to prevent undue influence.
DIVIDENDS ON YOUR WALMART STOCK
If you have Walmart stock in your accounts, your accounts
will be credited with any dividends paid by Walmart Inc.
with respect to its stock. Dividends allocated to your Pretax
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Account, your Company Funded 401(k) Account or your
401(k) Rollover Account will be automatically reinvested
in Walmart stock. Dividends allocated to your Company
Funded Profit Sharing Account (and Profit Sharing Rollover
Account) will also be reinvested in Walmart stock, except as
noted below.
If you are an active participant (excludes beneficiaries and
alternate payees, as defined in the If you get divorced section)
with six or more years of service, you have an option to take
a cash payout of any dividends paid on Walmart stock held
in your Company Funded Profit Sharing Account or Profit
Sharing Rollover Account (even if those amounts have been
converted to a Roth Account or a Roth Rollover Account).
Also, if you are a terminated participant who had more than
six years of service when you terminated and you continue
to maintain your accounts in the Plan after you leave, you will
have the option to elect a cash payout of dividends paid on
Walmart stock held in your Company Funded Profit Sharing
Account or Profit Sharing Rollover Account (even if those
amounts have been converted to a Roth Account or a Roth
Rollover Account). If you do not opt for the cash payout, your
dividends will be reinvested in Walmart stock.
You may make an election any time by calling the Customer
Service Center at 888-968-4015. Your most recently filed
election will apply to all subsequent dividends until you
change your election. (You may change your election only
once each business day.) Keep in mind that your election
must be made no later than the close of business on the
day prior to the record date for the dividend in order to be
effective for that dividend. You will not be able to make any
elections or election changes during the period from the
record date of the dividend through the dividend pay date
(which is usually three to four weeks after the record date).
Each year, Walmart Inc. releases the quarterly record dates
for dividend payouts. You can find this information on
walmart.com. You may also contact the Customer Service
Center at 888-968-4015 if you need information about
upcoming record dates for dividends. Keep in mind that a
dividend payout is taxable to you.
Note that if you request a hardship payout within five
business days of the record date for a dividend and you have
the right to elect a cash distribution of the dividend, tax laws
require that the dividend be automatically paid to you in cash.
Account balances and statements
At least once a year, you’ll receive a statement on your
accounts showing contributions made by you and by
Walmart, if any, the performance of your investment
options, the values of your accounts and fees assessed to
your account. You can easily get information about your
accounts, including a quarterly statement, at any time
online at benefits.ml.com or by calling the Customer
Service Center at 888-968-4015. You can also request a
paper copy of any quarterly statement at any time free of
charge by calling the Customer Service Center.
FEES CHARGED TO YOUR ACCOUNT
Administrative and investment fees may be assessed to
your accounts. Information on fees can be found in the
Annual Participant Fee Disclosure Notice and online at
benefits.ml.com.
Receiving a payout while working
for Walmart
Generally, you are not entitled to a payout from the
Walmart 401(k) Plan until you stop working for Walmart.
However, in the following limited situations you may be
entitled to receive a payout or loan of some or all of your
vested accounts while you’re still working:
• In the case of a financial hardship or after you reach age 59½.
• In connection with the birth or adoption of your child.
• Rollovers can be withdrawn at any time.
• You may request a loan from your Plan account.
It’s important to understand how any type of payout or loan
from the Walmart 401(k) Plan affects your tax situation.
For more information, see The income tax consequences
of a payout later in this summary.
Note that if you become an associate of Walmart or any
subsidiary as the result of the acquisition of your prior
employer, and you participated in your prior employer’s
401(k) plan and that plan was merged into this Plan, you may
have other withdrawal options with respect to amounts from
your prior employer’s plan. For more information regarding
withdrawal options available for your other accounts by
calling the Customer Service Center at 888-968-4015.
FINANCIAL HARDSHIP WITHDRAWALS
You may withdraw some or all of your vested Account
as necessary to meet a “financial hardship.” You will be
required to certify that you have insufficient cash or other
liquid assets to satisfy the need.
Under IRS guidelines, a financial hardship may exist if the
request is for:
• Payment of medical care expenses not covered by
insurance for you, your spouse, your dependents or your
affirmatively designated primary beneficiary
• Costs directly related to the purchase of your primary
residence
• Payment of tuition, fees, and room and board expenses for
up to the next 12 months of post‑high school education for
you, your spouse, your dependents or your affirmatively
designated primary beneficiary
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• Payments necessary to prevent eviction from, or
foreclosure on, your primary residence
• Payment for burial or funeral expenses for your deceased
parent, spouse, children, dependent, or your affirmatively
designated primary beneficiary, or
• Expenses for the repair of damage to your principal
residence that would qualify for a casualty deduction under
federal income tax rules (determined without regard to
whether the casualty was a federally‑declared disaster and
whether the loss exceeds 10% of your adjusted gross income).
• Expenses and losses (including loss of income) incurred
by you on account of a disaster declared by the Federal
Emergency Management Act (FEMA) under the Robert
T. Stafford Disaster Relief and Emergency Assistance
Act, provided your principal residence or principal place
of employment at the time of the disaster was in an area
designated for individual assistance with respect to disaster.
Federal tax law requires that you must have already obtained
all in‑service payouts available (including in‑service withdrawals
of rollover contributions and withdrawals after age 59½),
before you can request a financial hardship payout. Also,
please note that if you request a financial hardship payout
within five business days of the record date of a dividend and
you are entitled to elect a cash payout of that dividend, the
dividend will automatically be distributed to you in cash.
A financial hardship payout is immediately taxable to you
(other than Roth contributions and, if the payout is a qualified
distribution, earnings on your Roth contributions), including a
10% penalty tax if you are under age 59½ or if the payout is not
for certain medical purposes. For more information, see The
income tax consequences of a payout later in this chapter.
You can make a request for a financial hardship payout
online at benefits.ml.com or by calling the Customer
Service Center at 888-968-4015.
WITHDRAWALS AFTER YOU REACH AGE 59½
Any time after you reach age 59½, you may elect to withdraw
all or any portion of your Plan accounts, to the extent vested,
even though you are still working for Walmart. You can make
a request for a withdrawal online at benefits.ml.com or by
calling the Customer Service Center at 888-968-4015.
WITHDRAWALS RELATED TO THE BIRTH OR
ADOPTION OF YOUR CHILD
Beginning February 1, 2022, you may request a withdrawal
of up to $5,000 from the vested portion of your Plan
account within one year of the birth or adoption of
your child. In the case of adoption, the adoptee must be
under the age of 18 or physically or mentally incapable of
self‑support, and must not be the child of your spouse. You
are required to make a representation to the Plan that the
withdrawal is related to the birth or adoption of your child.
NOTE: Your distribution will not be considered a qualified
birth or adoption distribution unless you include the name,
age, and taxpayer identification number of the child or
adoptee on your federal income tax return for the year in
which the distribution is made.
WITHDRAWALS OF ROLLOVER CONTRIBUTIONS
You may withdraw all or any portion of your Pretax Rollover
Account, Roth Rollover Account, and your Profit Sharing
Rollover Account at any time even if you are still working
for Walmart or its subsidiaries. (Note that prior to February
1, 1998, the Plan accepted rollovers to a profit‑sharing
rollover account, but this option is no longer available.)
PLAN LOANS
You may apply for a loan from the vested portion of your
Plan account while you are still working for Walmart. The
Administrator has established a written loan program
explaining the Plan’s loan requirements in detail. You can
request a copy of the loan program or make a request for a
loan online at benefits.ml.com or by calling the Customer
Service Center at 888-968-4015.
Generally, the rules for loans include the following:
• The maximum loan amount is limited by IRS rules, which
generally limit your total loan balances to the lesser of
(1) 50% of the total of your vested Plan account or (2)
$50,000 (reduced by the excess, if any, of your highest
outstanding loan balance during the one‑year period prior
to the date of the loan over your current outstanding
balance of loans). The minimum loan amount is $1,000.
• All loans must be secured by a pledge of up to one‑half of
your vested Plan account.
• A fee will be charged to process your loan application.
Additional fees may be accessed for residential loans.
(Fee amounts may change from time to time.)
• All loans bear a commercially reasonable rate of interest
set by the Administrator from time to time.
• Loans must be repaid in regular installments over a one‑
to five‑year period, unless you are using the loan proceeds
to buy a house for yourself, in which case the repayment
period may be longer as set forth in the written loan
program from time to time.
• You may have only one general purpose loan and one
residential loan outstanding at any time.
• All loans are considered a directed investment from your
account under the Plan. Your payments of principal and
interest on the loan are credited to your Plan accounts.
• If you fail to make payments when due under the loan,
you will be considered to be in default. Under certain
circumstances, a loan that is in default may be considered
a distribution from the Plan. The significance of the loan
balance being treated as a distribution is that the amount
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of this distribution (other than Roth contributions) is
taxable to you as ordinary income and could be subject to
excise taxes. A Form 1099‑R will be issued to you and the
total amount of the distribution will be reported to the IRS.
When you are on an authorized unpaid leave of absence, you
may be excused from making scheduled loan repayments
for a period of up to one year. If you have an outstanding
loan when you are called to qualified military service, special
rules under USERRA may apply. Call the Customer Service
Center at 888-968-4015 for more details.
If you die: your designated beneficiary
In the event of your death, your entire Plan balance will
be paid out to your beneficiary. It is very important for
you to keep your beneficiary information up to date.
Beneficiary choices must be made at One.Walmart.com.
For active associates, starting February 1, 2020, only
beneficiary designations made online will be accepted. If
you are no longer employed by Walmart, you may obtain a
paper beneficiary designation form by contacting People
Services. (Note that your spouse’s consent must still be
completed on Form B, as explained below.) Since your
spouse or partner has certain rights in the death benefit,
you should immediately update your beneficiary election if
there is a change in your relationship status.
If you have a spouse and wish to name someone other than
your spouse as your designated beneficiary, your spouse
must consent to that designation. You must complete the
Alternate Beneficiary Form for Married Participants Form
B and your spouse must complete the Spousal Consent
portion of that form. The Spousal Consent form must be
notarized and must accompany the Form B in order to be
valid. Form B and the Spousal Consent form can be found
on OneWalmart. Any beneficiary designation you make will
be effective for all of your Plan accounts.
If you do not designate a beneficiary, your death benefit
will be distributed in accordance with the Plan’s default
provisions in the following order, as stated below:
• Spouse or partner (as defined below); if none, then
• Living children (stepchildren are not included); if none, then
• Living parents; if none, then
• Living siblings; if none, then
• Your estate, to be distributed per the terms of your will or
as a court determines.
Please note that if you designate your spouse as your
beneficiary and you later divorce, your beneficiary
designation will not be effective after the divorce unless
you complete a new beneficiary designation form. Similarly,
if you do not have a spouse and you later marry, your prior
beneficiary designation will not be effective after the
marriage unless you complete a new designation form with
your spouse’s consent.
Also, note that if you designate a beneficiary and your
beneficiary dies before the benefit check is issued, the
benefit will be paid to your contingent beneficiary or, if none,
under the default rules above. If your beneficiary dies after
the benefit check has been issued, the benefit will be paid to
your beneficiary’s estate. Note, however, that if your spouse
or partner is your beneficiary, the benefit will always be paid
to the spouse’s or partner’s estate if he or she dies after you
but before the benefit is paid. Again, it is very important
for you to keep your beneficiary information up to date.
Beneficiary choices should be made at One.Walmart.com.
NOTE: Effective June 26, 2013, your same‑sex spouse is
treated in the same manner as an opposite‑sex spouse for
Plan purposes. Keep in mind that if you had a same‑sex
spouse on that date, any beneficiary designation you had in
effect which designated someone other than your spouse as
your beneficiary became invalid on that date. Your spouse
will automatically be your beneficiary unless you make a
new beneficiary designation with your spouse’s consent.
Effective January 1, 2014, if you have a “partner” and you
have not made an affirmative beneficiary designation, your
partner will be your beneficiary unless you affirmatively
designate a different beneficiary (regardless of whether
the designation occurred before or after your partnership
began). Your “partner” for Plan purposes means:
• Your domestic partner, as long as you and your
domestic partner:
– Are in an ongoing, exclusive and committed relationship
similar to marriage and have been for at least 12 months
and intend to continue indefinitely;
– Are not married to each other or to anyone else;
– Meet the age for marriage in your home state and are
mentally competent to consent to contract in that state;
– Are not related in a manner that would bar a legal
marriage in the state in which you live, and
– Are not in the relationship solely for the purpose of
obtaining benefits coverage, or
• Any other person to whom you are joined in a legal
relationship recognized as creating some or all of the
rights of marriage in the state or country in which the
relationship was created.
You should take action to ensure that your beneficiary
under the Plan reflects your current intent. Beneficiary
choices should be made at One.Walmart.com.
BENEFICIARY DESIGNATIONS MADE BEFORE
OCTOBER 31, 2003
If you made a beneficiary designation under the 401(k)
Plan on or before October 31, 2003, that designation
will continue to apply to your Pretax Account, your Roth
Account, your Company Funded 401(k) Account, your
Company Match Account, and your Rollover Accounts.
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Similarly, if you made a beneficiary designation under the
Profit Sharing Plan on or before October 31, 2003, that
designation will continue to apply to your Company Funded
Profit Sharing Account and Profit Sharing Rollover Account.
If you change your beneficiary designation after October
31, 2003, it will apply to all Plan accounts and any prior
designations will be ineffective.
Note that changes in your relationship status may affect
your beneficiary designation, as explained above.
Again, it is very important for you to keep your beneficiary
information up to date. Beneficiary designations should be
made at One.Walmart.com.
If you get divorced
If you go through a divorce, all or part of your Plan balance
may be awarded to an “alternate payee” in the court order,
called a “qualified domestic relations order” (QDRO). An
alternate payee may be your spouse or former spouse,
child or other dependent. (Federal law at this time does
not permit the recognition of a QDRO for a partner
unless the partner is also a dependent of the participant.)
Because there are very strict requirements for these
cases, you should contact the QDRO Administrator at
877-MER-QDRO (877-637-7376) for a free copy of the
procedures your attorney should use in drafting the court
order. After the court order is received by the QDRO
Administrator, it must be reviewed to determine if it meets
legal requirements for this type of order and will take a
period of time to be processed. The administrative fee for
processing your QDRO will be charged to your account or
as directed in the Order.
If you leave Walmart
When you stop working for Walmart, you are entitled to
receive a payout of your vested accounts in the Plan.
It is important to understand how any type of payout from
the Walmart 401(k) Plan affects your tax situation. For more
information, see The income tax consequences of a payout
later in this summary.
You may elect to receive your payout 30 calendar days after
your termination is entered into the payroll system. For
example, if your termination is entered into and processed
by the payroll system on July 19, 2021, you may elect your
payout on or after August 18, 2021.
A notice informing you that you are entitled to payment
will normally be mailed to your home address or sent
electronically, based on your delivery elections, after
you leave Walmart and its subsidiaries. Please make sure
that your address is correct on your payroll check when
you leave Walmart and its subsidiaries or that you give a
forwarding address during your exit interview. If you have
not received any information regarding your payout within
60 days of your termination date, contact the Customer
Service Center at 888-968-4015. To request your payout,
you will need to access your account on benefits.ml.com or
by calling the Customer Service Center at 888-968-4015.
Your consent to the payout is not required and payout of your
entire vested account will automatically be made to you:
• If your total vested Plan balance is $1,000 or less at
any time. This automatic payout will be made as soon as
possible after the last business day of the third calendar
month following the calendar month in which your
termination date is entered into the payroll system, unless
you consent to an earlier payout, as described above. In
the example above, if your account is eligible for automatic
payout and you do not consent to payout on or after
August 19, 2021, your payout will automatically be made to
you as soon as possible after October 31, 2021, or
• If you are over age 70, regardless of the amount of your
total vested Plan balance. This automatic payout will be
made as soon as possible after the last business day of the
second calendar month following the calendar month in
which you turn age 70, unless you consent to an earlier
payout as described above. For instance, if you turn age
70 in July 2021 and your account is eligible for automatic
payout, and you do not consent to payout, your payout
would automatically be made on the first scheduled date
after September 30, 2021, according to Plan provisions.
Note that if you do not reach age 70 on or before
February 1, 2022, your account will not be distributed to you
automatically until after the last business day of the second
calendar month following the calendar month in which you
turn age 71½, unless you consent to an earlier distribution.
If your total vested Plan balance is more than $1,000 and
you are under age 70 (or, if you do not reach age 70 on or
before February 1, 2022, age 71½), you must consent to
payout of all or any portion of your account. Payout will be
made as soon as possible after the Customer Service Center
receives your consent, but no earlier than 30 calendar days
after your termination is entered into the payroll system.
If your total vested Plan balance is more than $1,000, you
can choose to delay some or all of your payout until any date
up to age 70 (or, if you do not reach age 70 on or before
February 1, 2022, up to age 71½), but your Plan balance will
be subject to an annual maintenance fee and possibly other
expenses. For information regarding these charges, refer to
the Annual Participant Fee Disclosure Notice. If you choose
to delay your payout, you will be able to continue to make
changes in your investment choices just as you did while you
were an active participant in the Plan.
If you return to work with Walmart before your payout is
completed, the payout will be canceled and no payout will
be made from your account.
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THE AMOUNT OF YOUR PAYOUT
The entire value of your Pretax Account, your Roth Account,
your Company Funded 401(k) Account, your Rollover
Accounts, and the Company Match Account will be available
to be paid out to you. In addition, if you have a Company
Funded Profit Sharing Account (see Your Walmart 401(k)
Plan accounts earlier in this summary), the vested portion
of your Company Funded Profit Sharing Account will also
be available for payout to you. You will forfeit (give up) the
nonvested portion of your Company Funded Profit Sharing
Account, as explained in the Vesting in your company
funded profit sharing account earlier in this summary.
The amount you will receive will be based on the value of
your accounts as of the date the payout is processed. If a
cash payout is made directly to you rather than rolled over
to an IRA or other employer plan, applicable taxes will be
withheld from your check.
A check processing fee will be applied to your Plan balance
when it is paid out to you.
HOW YOU RECEIVE YOUR PAYOUT
You have several options for receiving your payout.
Your accounts will normally be paid to you in cash. However,
you may elect to have your Company Funded Profit Sharing
Account and Profit Sharing Rollover Account (even if those
amounts have been converted to your Roth Account or
Roth Rollover Account) distributed to you in the form of
Walmart stock (even if it is not invested in Walmart stock
at the time your payout is processed) or partly in cash and
partly in Walmart stock. (Only whole shares of Walmart
stock will be distributed; partial shares will be distributed
in cash.) You may also elect to have your Pretax Account,
your Company Funded 401(k) Account, and your Rollover
Accounts (even if those amounts have been converted to
your Roth Account or Roth Rollover Account) paid to you
in Walmart stock to the extent those accounts are invested
in Walmart stock at the time your payout is processed. Any
part of those accounts not invested in Walmart stock at the
time of your payout will be distributed in cash.
If the total of your vested accounts is $1,000 or less, or if you
are over age 70 (or, if you do not reach age 70 on or before
February 1, 2022, if you are over age 71½) (regardless of the
amount of your vested accounts), your payout will be made
directly to you in a single cash payout. If you wish to take
any of your payout in the form of Walmart stock or if you
wish to roll over your payout to an IRA or other employer
plan, you must contact the Customer Service Center at
888-968-4015 with your payout instructions within the time
period shown in your payout notice. If you fail to contact the
Customer Service Center in a timely manner, your payout
will be made in a single cash payment to you.
If the total of your vested accounts in the Plan is more
than $1,000, your payout will not be made until you make
an election regarding the form of payout and consent to
the distribution, or until you reach age 70 (or, if you do
not reach age 70 on or before February 1, 2022, until you
reach age 71½). You can choose to take all or any portion
of your vested account. (Note, however, that if you take a
partial payout of your account and the amount remaining in
your account drops to $1,000 or less, it will be cashed‑out
as explained above.) To obtain your payout, contact the
Customer Service Center at 888-968-4015.
Your accounts normally will be distributed directly to you,
unless you elect to roll them over to an IRA or to another
employer’s retirement plan.
NOTE: If your vested account cannot be paid to you
because you cannot be found, the Administrator will make
a diligent attempt to locate you. If you still cannot be found,
your vested account will be forfeited. If you are later found,
your account will be reinstated but you will not receive any
earnings for the period after forfeiture. (This also applies
if you die and your beneficiary cannot be located.) Thus, it
is important that you make sure you update your contact
information if there is a change.
If you leave and are rehired
by Walmart
If you leave Walmart and its subsidiaries and are later rehired as
an eligible associate, you will be immediately eligible to make
your own contributions to the Plan on your date of rehire.
If you leave Walmart and its subsidiaries after you became
eligible to receive matching contributions and are later
rehired by Walmart, you will automatically be eligible
to receive matching contributions on your rehire date.
Similarly, if you leave Walmart and its subsidiaries after
you have met the 1,000‑hour requirement for matching
contribution eligibility but before your actual participation
date, you will be eligible to receive matching contributions
beginning on the later of the date you would have initially
become a participant or your rehire date (with respect to
contributions you make after that date). If you were not a
participant when you left, or had not satisfied the 1,000‑
hour requirement, you will be treated as a new associate
when you are rehired and will be required to complete the
eligibility requirements (see When participation begins
earlier in this summary) in order to be eligible to receive
matching contributions under the Plan.
THE NONVESTED PORTION OF
YOUR COMPANY FUNDED PROFIT
SHARING ACCOUNT
When you terminate employment, the portion of your
Company Funded Profit Sharing Account that is not vested
(if any) will not be paid to you. This nonvested amount is
called a “forfeiture.”
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• If you receive a total payout of your vested Plan balance after
your termination of employment and while your Company
Funded Profit Sharing Account is partially vested, the
nonvested portion of your Company Funded Profit Sharing
Account will be forfeited on the date of your payout.
• If you do not receive a total payout of your vested Plan
balance after your termination of employment, the
nonvested portion of your Company Funded Profit Sharing
Account will not be forfeited until you have five consecutive
“breaks in service.” A break in service is a Plan year
(February 1–January 31) in which you are credited with 500
hours of service or less. If you are absent from work due to
an FMLA leave and have worked 500 hours or less in the Plan
year, you will be credited with enough hours to bring you up
to 500.01 hours so that you will not incur a break in service.
The nonvested portion of your Company Funded Profit
Sharing Account that was forfeited will be reinstated (at its
former value) if you are rehired by Walmart or subsidiary
before you have five consecutive breaks in service and
you pay back to the Plan the total amount of your payout
within five years after you are rehired. If you return to
work with Walmart or a subsidiary after five or more
consecutive breaks in service, or if you chose not to repay
your payout as discussed above, the nonvested portion of
your Company Funded Profit Sharing Account that was
forfeited will not be reinstated.
If you were zero percent vested in your Company Funded
Profit Sharing Account when you terminated employment,
your nonvested Company Funded Profit Sharing Account
will automatically be reinstated if you are rehired prior to
five consecutive breaks in service.
Forfeitures of nonvested Company Funded Profit Sharing
Accounts of terminated participants generally are used to
pay Plan expenses and for certain other purposes, such as to
restore account balances as discussed above.
When you are rehired, your years of service with Walmart
before you left will be counted for purposes of determining
your vesting in your Company Funded Profit Sharing
Account.
The income tax consequences
of a payout
The tax consequences of your participation in the Plan are
your responsibility. This explanation is only a brief description
of the U.S. federal tax consequences related to your
participation in the Plan. This description is based on current
law and current interpretations of the law by the Internal
Revenue Service. Because the law is subject to change and
because the application of the law may vary depending on
your particular circumstances, this description is general in
nature and you should not rely on it in determining your tax
consequences. You are strongly urged to consult a tax advisor.
Walmart is entitled to a deduction on the amount of its
contributions, as well as your contributions, to the Plan. Your
pretax contributions and Walmart’s contributions to the
Plan, as well as earnings on those contributions, generally
are not subject to federal income taxes until they are paid
to you (or you elect to make an In‑Plan Roth Conversion of
such amounts). You are taxed on your Roth contributions
when you contribute them to the Plan. Earnings on Roth
contributions are not taxed unless you take a distribution
that is not a qualified distribution. (See Taxation of payouts
of Roth contributions below.)
POSTPONE PAYING TAXES ON PAYOUTS
THROUGH A ROLLOVER (OTHER THAN A ROTH
IRA ROLLOVER)
Although payouts from the Plan (other than from your Roth
and Roth Rollover Accounts) are subject to federal income
taxes, the Internal Revenue Code provides favorable tax
treatment to payouts in certain circumstances. For example,
you can postpone paying taxes on your payout if you direct
the Plan to issue your payout directly to an IRA or to another
employer’s qualified retirement plan, a 403(b) plan or a
governmental 457 plan. This is called a direct rollover. (The
check will be made payable to the IRA or other plan trustee
and will be delivered to you or your IRA or rollover institution.
If the check is mailed to you, you will be responsible for
delivering it to the IRA or other plan trustee within 60 days.)
If you elect this method for your payout, no taxes will be
withheld from the amount you are rolling over. It will not
be taxed until you later receive a payout from the IRA or
other plan.
If you do not elect to have your payout directly rolled over,
federal law requires that Walmart withhold 20% of the
payout for federal taxes, in addition to any required state
withholding. In some cases, 20% withholding may not be
enough, which could mean that you will owe additional taxes
when you file your income tax return.
If you do not elect a direct rollover (and instead receive an
actual payout from the Plan), you may still roll over those
funds to an IRA or an employer’s qualified retirement
plan, 403(b) plan or governmental 457 plan, as long as
you do so within 60 calendar days after you received the
distribution. The amount rolled over will not be subject to
federal income tax until you take it out of the IRA or other
plan. If you want to roll over 100% of your payout to an IRA
or other plan, however, you will have to use other money to
replace the 20% that was withheld from your payout. If you
roll over only the 80% that you received, you will be taxed
on the 20% that was withheld.
NOTE: You may roll over all or any portion of your account
that is eligible for rollover to a Roth IRA. Any amount rolled
over that would have been taxable if not rolled over will be
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taxable at the time of the rollover to the Roth IRA. (Note
that you may voluntarily choose to have taxes withheld from
amounts at the time you roll over to a Roth IRA.)
For more information regarding these rollover rules,
review the Special tax notice addendum that follows.
Retain this addendum for review when you are eligible to
take a distribution.
TAXATION OF PAYOUTS OF
ROTH CONTRIBUTIONS
Your Roth contributions and earnings on those contributions
are not taxed when distributed from the Plan as long as
the distribution is a “qualified” distribution. A “qualified”
distribution is a distribution that is made: (1) on account of
your death, disability, or after you attain age 59½, and (2)
after you have completed a five‑year participation period.
The five‑year participation period is the five‑year period
beginning with the first calendar year in which in which you
first make a Roth contribution to the Plan (or to another
401(k) plan or 403(b) plan, if such amount was rolled over to
this Plan) and ending on the last day of the fourth calendar
year thereafter. For instance, if you make your first Roth
contribution in July 2020, your five‑year participation period
will end on December 31, 2024. It is not necessary that you
make a Roth contribution in each of the five years.
If you receive a distribution from your Roth contributions
and earnings on those contributions that is not a “qualified”
distribution, the earnings on your Roth contributions will
be taxable to you at the time of distribution (unless you roll
over the distribution to a Roth IRA or a designated Roth
account in another employer plan). If you do roll over your
Roth contributions and earnings, you will not have to pay
taxes currently on the earnings and you will not have to pay
taxes later on payouts that are qualified distributions.
Your Roth contributions may be rolled over only to a Roth
IRA or a designated Roth account in another employer plan.
If the rollover is to a designated Roth account in another
employer plan, the rollover generally must be a direct
rollover (unless the amount being rolled over includes only
amounts that would have been taxable if distributed to you).
NOTE: if you elect an In‑Plan Roth Conversion, the
amount converted is treated as a Roth contribution made
at the time of the conversion. When those amounts are
later distributed, the rules described above generally
apply. For this purpose, an In‑Plan Roth Contribution will
be considered a contribution for purposes of starting the
five‑year participation period described above.
For more information regarding these rollover rules, review
the Special tax notice addendum: Roth contributions that
follows. Retain this addendum for review when you are
eligible to take a distribution.
EARLY WITHDRAWAL PENALTY
If you take a payout prior to age 59½ rather than rolling
it over, in most cases you will be subject to a 10% early
withdrawal penalty by the IRS on the taxable portion of
your payout. Thus, Roth contributions and, if they are
distributed in a “qualified” distribution, earnings on those
contributions, are not subject to the 10% early withdrawal
penalty. There are some other exceptions to the penalty,
such as death, disability, retirement after age 55, payouts for
certain medical expenses, and payouts related to the birth or
adoption of your child. Special rules also apply to distributions
made to reservists who are called to active military duty.
TAXATION OF PAYOUTS OF WALMART STOCK
There are also special rules for distributions of Walmart
common stock. If you receive cash (in excess of $200) in
addition to Walmart stock and the cash is not directly rolled
over, some withholding may apply, but the withheld amount
will not be greater than the amount of cash you receive.
Generally, if you receive Walmart common stock as part of
your payout that is not rolled over, you are taxed only on the
value of the stock at the time it was purchased by the Plan.
Keep in mind that if you elect cash payouts of dividends
paid on Walmart stock held in your Company Funded Profit
Sharing Account, the dividend is taxable to you and is not
eligible for rollover. The dividend is also taxable if you request
a financial hardship payout from your account within five
business days of the record date for a dividend and the
dividend is automatically paid out to you in cash. The dividend
payout is not subject to the 10% early withdrawal penalty
discussed above. In some cases, Walmart Inc. will be entitled
to deduct dividends paid on shares subject to this election.
TAXATION OF PAYOUTS TO BENEFICIARIES
AND ALTERNATE PAYEES
The tax treatment discussed above applies only to payouts
to participants. Different rules may apply to payouts to
beneficiaries of deceased participants. In general, if your
spouse is your beneficiary, he or she will have the same
federal income tax treatment and rollover options that you
would have had. Other beneficiaries, including partners, will
only be entitled to a direct rollover to an inherited IRA or
Roth IRA. The 10% early withdrawal penalty does not apply
to payouts to your beneficiary.
The spouse or former spouse of a participant who receives
a payout from the Plan under a qualified domestic relations
order (QDRO) generally has the same federal income tax
treatment and options as the participant would have had. In
some cases, however, a payout on behalf of a non‑spouse
dependent, including a partner, pursuant to a QDRO (e.g.,
state‑ordered child support) may result in federal income
taxation to the participant even though the payout is made
to or on behalf of the dependent alternate payee.
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TAXATION OF LOANS
Under current tax law, loans made from the Plan,
regardless of their purpose, are not considered taxable
income to the participant unless a default occurs. If you
default on a loan from the Plan (as discussed above), your
tax statement will show the amount of income to report
for the year of the default. You may also be subject to 10%
early withdrawal penalty.
TAXATION OF QUALIFIED BIRTH OR
ADOPTION DISTRIBUTIONS
If you receive a distribution related to the birth or adoption
of your child, the distribution is taxable to you for federal
income tax purposes, but is not subject to the 10% early
withdrawal penalty. You may not roll over the distribution
and Walmart is not required to withhold 20%, but you may
voluntarily elect withholding.
Filing a Walmart 401(k) Plan claim
If you think you are entitled to a benefit beyond that
processed by the Plan’s recordkeeper (Bank of America),
you may file a claim with the Administrator or its delegate at:
Walmart Inc.
Attn: 401(k) Plan Administrator
508 SW 8th Street
Bentonville, Arkansas 72716-0295
For questions about filing a claim, contact People Services
at 800-421-1362.
If your claim is partially or fully denied, you will receive
written notice of the decision within a reasonable time, but
no later than 90 days after the Administrator receives your
claim. The Administrator or its delegate can extend this
period for up to an additional 90 days if it determines that
special circumstances require an extension. You will receive
notice of any extension before the expiration of the original
90‑day period. The written notice you receive will state
the specific reasons for the denial of your claim, a specific
reference to the provisions of the Plan upon which the denial
is based, and a description of the review procedures and the
time limits applicable to such procedures, including your
right to bring a court action following a denial on appeal.
If you do not agree with the decision of the Administrator
or its delegate, you can request a review of the decision
by the Administrator. The Administrator has discretionary
authority to resolve all questions concerning administration,
interpretation or application of the Plan. Your request must
be made in writing and sent to the Administrator at:
Walmart Inc.
Attn: Benefits Compliance
508 SW 8th Street
Bentonville, Arkansas 72716-0295
Your request must be made within 60 calendar days of the
denial. Your written request must contain all additional
information that you wish the Administrator to consider. If
you do not request a review within this time period, you will
be deemed to have waived your right to a review.
NOTE: Due to COVID, your 60‑day time period for
requesting a review of your claim has been extended. The
period from the date your claim is denied (but not earlier
than March 1, 2020) through the earlier of one year from
that date or the date that is 60 days after the announced
end of the National Emergency related to the COVID‑19
outbreak is disregarded.
The Administrator will promptly conduct the review.
Written notice of the Administrator’s decision on review will
be provided to you within 60 calendar days after the receipt
of your request, unless special circumstances require an
extension of up to 60 additional days. In those circumstances
where the review is delayed to allow you to provide additional
information necessary for a proper review, the length of the
delay will not be included in the calculation of the 60‑day
deadline and extension periods set forth above. The written
notice of the Administrator’s decision will include specific
reasons for the decision and will refer to the specific
provisions of the Plan on which the decision is based.
You must exhaust these procedures before you can file
a lawsuit with respect to your Plan benefits. If you file
a lawsuit, it must be filed within one year from the date
of your payout or, if no payout is made, the date your
request for benefits is denied, in whole or in part, by
the Administrator on appeal (or, if earlier, the date the
Administrator fails to respond to your claim or appeal
within the time periods provided above).
Administrative information
PLAN NAME
The legal name of the Plan is the Walmart 401(k) Plan.
PLAN SPONSOR AND ERISA PLAN
ADMINISTRATOR
Walmart Inc. is the Plan Sponsor. Its contact information for
matters pertaining to the Plan is:
Walmart Inc.
Attn: 401(k) Plan Administrator
508 SW 8th Street
Bentonville, Arkansas 72716-0295
800-421-1362
As the ERISA Plan Administrator, Walmart Inc. is responsible
for reporting and disclosure obligations under the Employee
Retirement Income Security Act of 1974 (ERISA) and
all other obligations required to be performed by plan
administrators under the Internal Revenue Code and
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ERISA, except for those obligations delegated to the
Administrator, the Benefits Investment Committee or the
trustee of the Trust. ERISA is the federal law that imposes
certain responsibilities on Walmart Inc., the Administrator,
the Benefits Investment Committee and the trustee with
respect to your retirement benefits.
Subsidiaries of Walmart Inc. are permitted to participate
in the Plan. You may obtain a list of subsidiaries currently
participating in the Plan by contacting People Services.
and holds contributions made to the Plan in trust and
invests those contributions according to the policies
established under the Plan.
AGENT FOR SERVICE OF LEGAL PROCESS
Corporation Trust Company
1209 Orange Street
Corporation Trust Center
Wilmington, Delaware 19801
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PLAN SPONSOR’S EMPLOYER
IDENTIFICATION NUMBER
71‑0415188
NAMED ADMINISTRATIVE FIDUCIARY
The individual from time to time holding the position
of Senior Vice President, Global Benefits Division, of
Walmart is the Administrator. The Administrator is the
named administrative fiduciary of the Plan. As the named
administrative fiduciary of the Plan, the Administrator is
generally responsible for the management, interpretation
and administration of the Plan, including but not limited
to eligibility determinations, benefit payments and other
functions required, necessary or advisable to carry out the
purpose of the Plan.
You may contact the Administrator at the following address:
Senior Vice President, Global Benefits Division/Administrator
Walmart Inc.
508 SW 8th Street
Bentonville, Arkansas 72716-0295
NAMED INVESTMENT FIDUCIARY
The Benefits Investment Committee is the named
investment fiduciary of the Plan. The Committee is
responsible for the Plan’s investment policies, including
selection of investment options to be made available under
the Plan and the selection of the default investment option.
You may contact the Benefits Investment Committee at the
following address:
Benefits Investment Committee
Walmart Inc.
508 SW 8th Street
Bentonville, Arkansas 72716-0295
PLAN TRUSTEE
Northern Trust Company
50 S. LaSalle Street
Chicago, Illinois 60603
One or more trusts hold all Plan assets, such as
contributions by participants and Walmart’s contributions.
As trustee of the Trust, Northern Trust Company receives
Service of legal process may also be made on the ERISA
Plan Administrator or the trustee.
PLAN NUMBER
003
PLAN YEAR
February 1 through January 31
TYPE OF PLAN
The Walmart 401(k) Plan is a defined contribution plan
(401(k), profit sharing, and employee stock ownership plan).
ASSIGNMENT
Because this is a retirement plan governed by ERISA and
other federal laws, your accounts cannot be assigned or used
as collateral for a loan, nor can your accounts be garnished
or be subject to bankruptcy proceedings. They can, however,
be part of a divorce settlement, as explained in the If you
get divorced section earlier in this summary. Additionally, in
some cases, the IRS may enforce a federal tax levy against
your accounts to repay federal taxes you owe.
NO PBGC COVERAGE
ERISA created a governmental agency called the Pension
Benefit Guaranty Corporation (PBGC). One of the purposes
of the PBGC is to insure the benefits payable under defined
benefit plans. The PBGC does not, however, provide coverage
for defined contribution plans. Because the Plan is a defined
contribution plan, it is not eligible for coverage by the PBGC.
PLAN AMENDMENT OR TERMINATION
Walmart reserves the right to amend or terminate the
Plan at any time. Amendments are made by Walmart’s
Board of Directors or by its Executive Vice President,
Global People Division. Neither the Plan nor the benefits
described in this summary may be orally amended. All oral
statements and representations have no force or effect,
even if the statements and representations are made by
a management associate of Walmart or a participating
subsidiary, by the Administrator, by any member of the
Benefits Investment Committee or by Merrill Lynch.
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You may obtain a copy of the formal Plan document by
writing to:
Walmart Inc.
Attn: Benefits Compliance
508 SW 8th Street
Bentonville, Arkansas 72716-0295
You can also contact the Customer Service Center at
888-968-4015.
MISTAKEN PAYOUTS
If any payout is made under the Plan to the wrong party,
or if a payout is made to the right party but in the wrong
amount, the Administrator can recover the mistaken
payout from the recipient by either reducing his or her
Plan account or future payouts due to the recipient, or may
demand that the recipient promptly repay the Plan.
STATEMENT OF ERISA RIGHTS
As a participant in this Plan, you are entitled to certain
rights and protections under ERISA. ERISA provides that all
Plan participants shall be entitled to:
• Examine, without charge, at the ERISA Plan
Administrator’s office and at other specified facilities,
all documents governing the Plan, including insurance
contracts and collective bargaining agreements, and
a copy of the latest annual report (Form 5500 series)
filed by the Plan with the U.S. Department of Labor and
available at the Public Disclosure Room of the Employee
Benefits Security Administration.
• Obtain, upon written request to the ERISA Plan
Administrator, copies of documents governing the
operation of the Plan, including insurance contracts and
collective bargaining agreements, and copies of the latest
annual report (Form 5500 series) and updated Summary
Plan Description. The ERISA Plan Administrator may
make a reasonable charge for the copies. Your request
must be mailed to:
Walmart Inc. — ERISA Section 104(b) Request
Attn: Benefits Compliance
508 SW 8th Street
Bentonville, Arkansas 72716-0295
• Receive a summary of the Plan’s annual financial report. The
ERISA Plan Administrator is required by law to furnish each
participant with a copy of the summary financial report.
• Obtain a statement telling you the current balance of
your account and the portion of your account that is
nonforfeitable (vested). This statement must be requested
in writing and is not required to be given more than once
every 12 months. The Plan must provide the statement
free of charge.
In addition to creating rights for Plan participants, ERISA
imposes duties upon the people who are responsible for the
operation of the Plan. The people who operate the Plan,
called “fiduciaries” of the Plan, have a duty to do so prudently
and in your interest and in that of other Plan participants and
beneficiaries. No one, including your employer or any other
person, may fire or otherwise discriminate against you in
any way to prevent you from obtaining a pension benefit or
exercising your rights under ERISA.
If your claim for a benefit is denied or ignored in whole or in
part, you have a right to know why this was done, to obtain
copies of documents relating to the decision without charge,
and to appeal any denial, all within certain time schedules.
Under ERISA, there are steps you can take to enforce the
above rights. For instance, if you request materials from
the Plan and do not receive them within 30 days, you may
file suit in a federal court. In such a case, the court may
require the ERISA Plan Administrator or the Administrator
to provide the materials and pay you up to $110 a day until
you receive the materials, unless the materials were not sent
because of reasons beyond the control of the ERISA Plan
Administrator or the Administrator. If you have a claim for
benefits that is denied or ignored, in whole or in part, you
may file suit in a state or federal court. In addition, if you
disagree with the Plan’s decision or lack thereof concerning
the qualified status of a domestic relations order, you may
file suit in a federal court.
If it should happen that Plan fiduciaries misuse the Plan’s
money, or if you are discriminated against for asserting your
rights, you may seek assistance from the U.S. Department
of Labor, or you may file suit in a federal court. The court
will decide who should pay court costs and legal fees. If you
are successful, the court may order the person you have
sued to pay these costs and fees. If you lose, the court may
order you to pay these costs and fees, for example, if it
finds your claim is frivolous.
If you have any questions about the Plan, you should
contact the ERISA Plan Administrator or the Administrator.
If you have any questions about this statement or about
your rights under ERISA, you should contact the nearest
regional office of the Employee Benefits Security
Administration, U.S. Department of Labor, listed in your
telephone directory, or the Division of Technical Assistance
and Inquiries, Employee Benefits Security Administration,
U.S. Department of Labor, 200 Constitution Avenue
NW, Washington, DC 20210. You may also obtain certain
publications about your rights and responsibilities under
ERISA by calling the publications hotline of the Employee
Benefits Security Administration.
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Special tax notice addendum
YOUR ROLLOVER OPTIONS
The law requires that participants receive this notice before
receiving a distribution from the Plan that is eligible to
be rolled over to an IRA or an employer plan. You may or
may not currently be eligible to receive a distribution from
the Plan. If you are eligible for a distribution, however,
you should review this notice carefully before you elect
a distribution from the Plan. This notice is intended to
help you decide whether to elect a rollover. If you are not
currently eligible for a distribution, you should retain this
notice and review it when you are eligible for a distribution.
Rules that apply to most payments from the Plan are
described in the General information about rollovers section.
Special rules that only apply in certain circumstances are
described in the Special rules and options section.
This notice describes the rollover rules that apply to payouts
from the Plan, other than those from a designated Roth
account. If you also receive a payment from your Roth or
Roth Rollover Account in the Plan, see the Special tax notice
addendum: Roth contributions addendum that follows
this notice.
GENERAL INFORMATION ABOUT ROLLOVERS
How can a rollover affect my taxes? You will be taxed on a
payment from the Plan if you do not roll it over. If you are
under age 59½ and do not do a rollover, you will also have
to pay a 10% additional income tax on early distributions
(generally, distributions made before age 59½), unless an
exception applies. However, if you do a rollover, you will not
have to pay tax until you receive payments later and the 10%
additional income tax will not apply if those payments are
made after you are age 59½ (or if an exception to the 10%
additional income tax applies).
What types of retirement accounts and plans may accept
my rollover? You may roll over the payment to either an IRA
(an individual retirement account or individual retirement
annuity) or an employer plan (a tax‑qualified plan, section
403(b) plan, or governmental section 457(b) plan) that
will accept the rollover. The rules of the IRA or employer
plan that holds the rollover will determine your investment
options, fees, and rights to payment from the IRA or
employer plan (for example, IRAs are not subject to spousal
consent rules, and IRAs may not provide loans). Further, the
amount rolled over will become subject to the tax rules that
apply to the IRA or employer plan.
Where may I roll over the payment? You may roll over the
payment to either an IRA (an individual retirement account
or individual retirement annuity, including a Roth IRA) or
an employer plan (a tax‑qualified plan, section 403(b) plan
or governmental section 457(b) plan) that will accept the
rollover. The rules of the IRA or employer plan that holds
the rollover will determine your investment options, fees
and rights to payment from the IRA or employer plan (for
example, no spousal consent rules apply to IRAs and IRAs
may not provide loans). Further, the amount rolled over will
become subject to the tax rules that apply to the IRA or
employer plan.
How do I do a rollover? There are two ways to do a rollover.
You can do either a “direct rollover” or a “60‑day rollover.”
If you do a “direct rollover,” the Plan will make the payment
directly to your IRA or an employer plan. You should contact
the IRA sponsor or the administrator of the employer plan
for information on how to do a direct rollover.
If you do not do a direct rollover, you may still do a rollover
by making a deposit into an IRA or eligible employer plan
that will accept it. You will have 60 days after you receive
the payment to make the deposit. If you do not do a direct
rollover, the Plan is required to withhold 20% of the payment
for federal income taxes (up to the amount of cash and
property received, other than employer stock). This means
that, in order to roll over the entire payment in a 60‑day
rollover, you must use other funds to make up for the 20%
withheld. If you do not roll over the entire amount of the
payment, the portion not rolled over will be taxed and will be
subject to the 10% additional income tax on early distributions
if you are under age 59½ (unless an exception applies).
How much may I roll over? If you wish to do a rollover, you
may roll over all or part of the amount eligible for rollover.
Any payment from the Plan is eligible for rollover, except:
• Required minimum distributions after age 70½ (if you were
born before July 1, 1949), after age 72 (if you were born
after June 30, 1949), or after death
• Hardship distributions
• Payments of employee stock ownership plan (ESOP)
dividends
• Corrective distributions of contributions that exceed tax
law limitations
• Loans treated as deemed distributions (for example,
loans in default due to missed payments before your
employment ends)
The Plan Administrator or the payor can tell you what
portion of a payment is eligible for rollover.
If I don’t do a rollover, will I have to pay the 10% additional
income tax on early distributions? If you are under age
59½, you will have to pay the 10% additional income tax on
early distributions for any payment from the Plan (including
amounts withheld for income tax) that you do not roll over,
unless one of the exceptions listed below applies. This tax
applies to the part of the distribution that you must include
in income and is in addition to the regular income tax on the
payment not rolled over.
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The 10% additional income tax does not apply to the
following payments from the Plan:
• Payments made after you separate from service if you will
be at least age 55 in the year of the separation
first‑time home purchase, and (3) payments for health
insurance after you have received unemployment
compensation for 12 consecutive weeks (or would have
been eligible to receive unemployment compensation but
for self‑employed status).
• Payments made due to disability
• Payments after your death
• Payments of ESOP dividends
• Corrective distributions of contributions that exceed tax
law limitations
• Payments made directly to the government to satisfy a
federal tax levy
• Payments made under a qualified domestic relations order
(QDRO)
• Payments of up to $5,000 made to you from a defined
contribution plan if the payment is a qualified birth or
adoption distribution
• Payments up to the amount of your deductible medical
expenses (without regard to whether you itemize
deductions for the taxable year)
• Certain payments made while you are on active duty if
you were a member of a reserve component called to duty
after September 11, 2001 for more than 179 days
• Payments excepted from the additional income tax
by federal legislation relating to certain emergencies
and disasters.
If I do a rollover to an IRA, will the 10% additional income
tax apply to early distributions from the IRA? If you
receive a payment from an IRA when you are under age
59½, you will have to pay the 10% additional income tax
on early distributions on the part of the distribution that
you must include in income, unless an exception applies.
In general, the exceptions to the 10% additional income
tax for early distributions from an IRA are the same as the
exceptions listed above for early distributions from a plan.
However, there are a few differences for payments from an
IRA, including:
• The exception for payments made after you separate
from service if you will be at least age 55 in the year of the
separation does not apply.
• The exception for qualified domestic relations orders
(QDROs) does not apply (although a special rule applies
under which, as part of a divorce or separation agreement,
a tax‑free transfer may be made directly to an IRA of a
spouse or former spouse).
• The exception for payments made at least annually in
equal or close to equal amounts over a specified period
applies (without regard to whether you have had a
separation from service).
• Additional exceptions apply for payments from an IRA,
including: (1) payments for qualified higher education
expenses, (2) payments up to $10,000 used in a qualified
Will I owe state income taxes? This notice does not
address any state or local income tax rules (including
withholding rules).
SPECIAL RULES AND OPTIONS
If your payment includes after-tax contributions: If you
have after‑tax contributions that were merged into the
Walmart 401(k) Plan, those contributions are subject
to special tax rules when they are distributed from the
Walmart 401(k) Plan. (See the following Addendum if you
have made Roth contributions to the Plan.)
After‑tax contributions included in a payment are not taxed.
If you receive a partial payment of your total benefit, an
allocable portion of your after‑tax contributions is included in
the payment, so you cannot take a payment of only after‑tax
contributions. However, if you have pre‑1987 after‑tax
contributions maintained in a separate account, a special rule
may apply to determine whether the after‑tax contributions
are included in the payment. In addition, special rules apply
when you do a rollover, as described below.
You may roll over to an IRA a payment that includes after‑tax
contributions through either a direct rollover or a 60‑day
rollover. You must keep track of the aggregate amount of
the after‑tax contributions in all of your IRAs (in order to
determine your taxable income for later payments from
the IRAs). If you do a direct rollover of only a portion of the
amount paid from the Plan and at the same time the rest
is paid to you, the portion rolled over consists first of the
amount that would be taxable if not rolled over. For example,
assume you are receiving a distribution of $12,000, of which
$2,000 is after‑tax contributions. In this case, if you directly
roll over $10,000 to an IRA that is not a Roth IRA, no amount
is taxable because the $2,000 amount not rolled over is
treated as being after‑tax contributions. If you do a direct
rollover of the entire amount paid from the Plan to two or
more destinations at the same time, you can choose which
destination receives the after‑tax contributions.
Similarly, if you do a 60‑day rollover to an IRA of only
a portion of a payment made to you, the portion rolled
over consists first of the amount that would be taxable
if not rolled over. For example, assume you are receiving
a distribution of $12,000, of which $2,000 is after‑tax
contributions, and no part of the distribution is directly
rolled over. In this case, if you roll over $10,000 to an IRA
that is not a Roth IRA in a 60‑day rollover, no amount is
taxable because the $2,000 amount not rolled over is
treated as being after‑tax contributions.
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You may roll over to an employer plan all of a payment that
includes after‑tax contributions, but only through a direct
rollover (and only if the receiving plan separately accounts
for after‑tax contributions and is not a governmental
section 457(b) plan). You can do a 60‑day rollover to an
employer plan of part of a payment that includes after‑tax
contributions, but only up to the amount of the payment
that would be taxable if not rolled over.
during which the offset occurs to complete your rollover.
A qualified plan loan offset occurs when a plan loan in good
standing is offset because your employer plan terminates,
or because you sever from employment. If your plan loan
offset occurs for any reason (such as a failure to make level
loan repayments that results in a deemed distribution),
then you have 60 days from the date the offset occurs to
complete your rollover.
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If you miss the 60-day rollover deadline: Generally, the
60‑day rollover deadline cannot be extended. However, the
IRS has the limited authority to waive the deadline under
certain extraordinary circumstances, such as when external
events prevented you from completing the rollover by the
60‑day rollover deadline. To apply for a waiver, you must file
a private letter ruling request with the IRS. Private letter
ruling requests require the payment of a nonrefundable
user fee. For more information, see IRS Publication 590,
Individual Retirement Arrangements (IRAs).
If your payment includes employer stock that you do
not roll over: If you do not do a rollover, you can apply a
special rule to payments of employer stock that are either
attributable to after‑tax contributions or paid in a lump sum
after separation from service (or after age 59½, disability,
or the participant’s death). Under the special rule, the net
unrealized appreciation on the stock will not be taxed when
distributed from the Plan and will be taxed at capital gain
rates when you sell the stock. Net unrealized appreciation is
generally the increase in the value of employer stock after it
was acquired by the Plan. If you do a rollover for a payment
that includes employer stock (for example, by selling the
stock and rolling over the proceeds within 60 days of
the payment), the special rule relating to the distributed
employer stock will not apply to any subsequent payments
from the IRA or generally, the Plan. The Plan Administrator
can tell you the amount of any net unrealized appreciation.
If you have an outstanding loan that is being offset: If you
have an outstanding loan from the Plan, your Plan benefit
may be offset by the outstanding amount of the loan,
typically when your employment ends. The loan offset
amount is treated as a distribution to you at the time of
the offset. Generally, you may roll over all or any portion
of the offset amount. Any offset amount that is not rolled
over will be taxed (including the 10% additional income tax
on early distributions, unless an exception applies). You may
roll over offset amounts to an IRA or an employer plan (if
the terms of the employer plan permit the plan to receive
plan loan offset rollovers).
How long you have to complete the rollover depends
on what kind of plan loan offset you have. If you have
a qualified plan loan offset, you will have until your tax
return due date (including extensions) for the tax year
If you were born on or before January 1, 1936: If you were
born on or before January 1, 1936 and receive a lump sum
distribution that you do not roll over, special rules for
calculating the amount of the tax on the payment might
apply to you. For more information, see IRS Publication 575,
Pension and Annuity Income.
If you roll over your payment to a Roth IRA: If you roll
over a payment from the Plan to a Roth IRA, a special rule
applies under which the amount of the payment rolled over
(reduced by any after‑tax amounts) will be taxed. In general,
the 10% additional income tax on early distributions will not
apply. However, if you take the amount rolled over out of the
Roth IRA within the five‑year period that begins on January
1 of the year of the rollover, the 10% additional income tax
will apply (unless an exception applies). If you roll over the
payment to a Roth IRA, later payments from the Roth IRA
that are qualified distributions will not be taxed (including
earnings after the rollover). A qualified distribution from
a Roth IRA is a payment made after you are age 59½ (or
after your death or disability, or as a qualified first‑time
homebuyer distribution of up to $10,000) and after you
have had a Roth IRA for at least five years. In applying this
5‑year rule, you count from January 1 of the year for which
your first contribution was made to a Roth IRA. Payments
from the Roth IRA that are not qualified distributions will be
taxed to the extent of earnings after the rollover, including
the 10% additional income tax on early distributions (unless
an exception applies). You do not have to take required
minimum distributions from a Roth IRA during your lifetime.
For more information, see IRS Publication 590, Individual
Retirement Arrangements (IRAs).
If you do a rollover to a designated Roth account in the Plan:
You cannot roll over a distribution to a designated Roth
account in another employer’s plan. However, you can roll
the distribution over into a designated Roth account in the
distributing Plan. If you roll over a payment from the Plan
to a designated Roth account in the Plan, the amount of
the payment rolled over (reduced by any after‑tax amounts
directly rolled over) will be taxed. In general, the 10%
additional income tax on early distributions will not apply.
However, if you take the amount rolled over out of the Roth
IRA within the 5‑year period that begins on January 1 of the
year of the rollover, the 10% additional income tax will apply
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(unless an exception applies). If you roll over the payment to
a designated Roth account in the Plan, later payments from
the designated Roth account that are qualified distributions
will not be taxed (including earnings after the rollover). A
qualified distribution from a designated Roth account is a
payment made both after you are age 59½ (or after your
death or disability) and after you have had a designated
Roth account in the Plan for at least 5 years. In applying this
5‑year rule, you count from January 1 of the year your first
contribution was made to the designated Roth account.
However, if you made a direct rollover to a designated
Roth account in the Plan from a designated Roth account
in a plan of another employer, the 5‑year period begins on
January 1 of the year you made the first contribution to
the designated Roth account in the Plan or, if earlier, to the
designated Roth account in the plan of the other employer.
Payments from the designated Roth account that are not
qualified distributions will be taxed to the extent of earnings
after the rollover, including the 10% additional income tax
on early distributions (unless an exception applies).
If you are not a plan participant
Payments after death of the participant. If you receive a
distribution after the participant’s death that you do not
roll over, the distribution generally will be taxed in the same
manner described elsewhere in this notice. However, the
10% additional income tax on early distributions does not
apply, and the special rule described under the section If you
were born on or before January 1, 1936 applies only if the
deceased participant was born on or before January 1, 1936.
If you are a surviving spouse: If you receive a payment from
the Plan as the surviving spouse of a deceased participant,
you have the same rollover options that the participant
would have had, as described elsewhere in this notice. In
addition, if you choose to do a rollover to an IRA, you may
treat the IRA as your own or as an inherited IRA.
An IRA you treat as your own is treated like any other IRA
of yours, so that payments made to you before you are age
59½ will be subject to the 10% additional income tax on early
distributions (unless an exception applies) and required
minimum distributions from your IRA do not have to start
until after you are age 70½ (if you were born before July 1,
1949) or age 72 (if you were born after June 30, 1949).
If you treat the IRA as an inherited IRA, payments from the
IRA will not be subject to the 10% additional income tax on
early distributions. However, if the participant had started
taking required minimum distributions, you will have to
receive required minimum distributions from the inherited
IRA. If the participant had not started taking required
minimum distributions from the Plan, you will not have to
start receiving required minimum distributions from the
inherited IRA until the year the participant would have been
age 70½ (if the participant was born before July 1, 1949) or
age 72 (if the participant was born after June 30, 1949).
If you are a surviving beneficiary other than a spouse:
If you receive a payment from the Plan because of the
participant’s death and you are a designated beneficiary
other than a surviving spouse, the only rollover option you
have is to do a direct rollover to an inherited IRA or Roth
IRA. Payments from the inherited IRA or Roth IRA will
not be subject to the 10% additional income tax on early
distributions. You will have to receive required minimum
distributions from the inherited IRA or Roth IRA.
Payments under a QDRO: If you are the spouse or former
spouse of the participant who receives a payment from the
Plan under a QDRO, you generally have the same options
and the same tax treatment that the participant would
have (for example, you may roll over the payment to your
own IRA or an eligible employer plan that will accept it).
However, payments under the QDRO will not be subject to
the 10% additional income tax on early distributions.
If you are a nonresident alien: If you are a nonresident
alien and you do not do a direct rollover to a U.S. IRA or
U.S. employer plan, instead of withholding 20%, the Plan
is generally required to withhold 30% of the payment for
federal income taxes. If the amount withheld exceeds the
amount of tax you owe (as may happen if you do a 60‑day
rollover), you may request an income tax refund by filing
Form 1040NR and attaching your Form 1042‑S. See Form
W‑8BEN for claiming that you are entitled to a reduced
rate of withholding under an income tax treaty. For more
information, see also IRS Publication 519, U.S. Tax Guide
for Aliens, and IRS Publication 515, Withholding of Tax on
Nonresident Aliens and Foreign Entities.
OTHER SPECIAL RULES
If your payments for the year are less than $200 (not
including payments from a designated Roth account in the
Plan), the Plan is not required to allow you to do a direct
rollover and is not required to withhold for federal income
taxes. However, you may do a 60‑day rollover.
You may have special rollover rights if you recently served
in the U.S. Armed Forces. For more information on special
rollover rights related to the U.S. Armed Forces, see IRS
Publication 3, Armed Forces’ Tax Guide. You also may have
special rollover rights if you were affected by a federally
declared disaster (or similar event), or if you received a
distribution on account of a disaster. For more information
on special rollover rights related to disaster relief, see the
IRS website at www.irs.gov.
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FOR MORE INFORMATION
You may wish to consult with the Plan Administrator or
payer, or a professional tax advisor, before taking a payment
from the Plan. Also, you can find more detailed information
on the federal tax treatment of payments from employer
plans in IRS Publication 575, Pension and Annuity Income;
IRS Publication 590, Individual Retirement Arrangements
(IRAs); and IRS Publication 571, Tax-Sheltered Annuity Plans
(403(b) Plans). These publications are available from a
local IRS office, on the web at www.irs.gov, or by calling
800-TAX-FORM.
age 59½, a 10% additional income tax on early distributions
(generally, distributions made before age 59½) will also
apply to the earnings (unless an exception applies). However,
if you do a rollover, you will not have to pay taxes currently
on the earnings and you will not have to pay taxes later on
payments that are qualified distributions.
If the payment from the Plan is a qualified distribution, you will
not be taxed on any part of the payment even if you do not
do a rollover. If you do a rollover, you will not be taxed on the
amount you roll over and any earnings on the amount you roll
over will not be taxed if paid later in a qualified distribution.
Special tax notice addendum: Roth
contributions
YOUR ROLLOVER OPTIONS
The law requires that participants receive this notice before
receiving a distribution from the Plan from your Roth
Account (or any Roth amounts that were merged into to the
Plan from your prior employer’s plan). You may or may not
currently be eligible to receive a distribution from the Plan.
If you are eligible for a distribution, however, you should
review this notice carefully before you elect a distribution
from the Plan. This notice is intended to help you decide
whether to elect a rollover. If you are not currently eligible
for a distribution, you should retain this notice and review it
when you are eligible for a distribution.
Rules that apply to most payments from your Roth or Roth
Rollover Account (referred to collectively in this addendum
as your “Roth Account”) are described in the General
information about rollovers section. Special rules that only
apply in certain circumstances are described in the Special
rules and options section.
Rules that apply to payments from the Plan other than from
your Roth Account are described in the separate Special tax
notice addendum above.
GENERAL INFORMATION ABOUT ROLLOVERS
How can a rollover affect my taxes? After‑tax contributions
included in a payment from your Roth Account are not
taxed, but earnings might be taxed. The tax treatment of
earnings included in the payment depends on whether the
payment is a qualified distribution. If a payment is only part
of your Roth Account, the payment will include an allocable
portion of the earnings in your Roth Account.
If the payment from the Plan is not a qualified distribution
and you do not do a rollover to a Roth IRA or a designated
Roth account in an employer plan, you will be taxed on the
portion of the payment that is earnings. If you are under
A qualified distribution from your Roth Account in the Plan
is a payment made after you are age 59½ (or after your
death or disability) and after you have had a Roth Account
in the Plan for at least 5 years. In applying the 5‑year rule,
you count from January 1 of the year your first contribution
was made to the Roth Account. However, if you did a direct
rollover to a Roth Account in the Plan from a designated
Roth account in another employer plan, your participation
will count from January 1 of the year your first contribution
was made to the Roth Account in the Plan or, if earlier, to
the designated Roth account in the other employer plan.
What types of retirement accounts and plans may accept
my rollover? You may roll over the payment to either a Roth
IRA (a Roth individual retirement account or Roth individual
retirement annuity) or a designated Roth account in an
employer plan (a tax‑qualified plan, section 403(b) plan, or
governmental section 457 plan) that will accept the rollover.
The rules of the Roth IRA or employer plan that holds the
rollover will determine your investment options, fees, and
rights to payment from the Roth IRA or employer plan
(for example, Roth IRAs are not subject to spousal consent
rules, and Roth IRAs may not provide loans). Further, the
amount rolled over will become subject to the tax rules that
apply to the Roth IRA or the designated Roth account in the
employer plan. In general, these tax rules are similar to those
described elsewhere in this notice, but differences include:
• If you do a rollover to a Roth IRA, all of your Roth IRAs will
be considered for purposes of determining whether you
have satisfied the 5‑year rule (counting from January 1 of
the year for which your first contribution was made to any
of your Roth IRAs).
• If you do a rollover to a Roth IRA, you will not be required
to take a distribution from the Roth IRA during your
lifetime and you must keep track of the aggregate amount
of the after‑tax contributions in all of your Roth IRAs (in
order to determine your taxable income for later Roth IRA
payments that are not qualified distributions).
• Eligible rollover distributions from a Roth IRA can only be
rolled over to another Roth IRA.
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How do I do a rollover? There are two ways to do a rollover.
You can either do a direct rollover or a 60‑day rollover.
If you do a direct rollover, the Plan will make the payment
directly to your Roth IRA or designated Roth account in an
employer plan. You should contact the Roth IRA sponsor or
the administrator of the employer plan for information on
how to do a direct rollover.
If you do not do a direct rollover, you may still do a rollover
by making a deposit (generally within 60 days) into a Roth
IRA, whether the payment is a qualified or nonqualified
distribution. In addition, you can do a rollover by making a
deposit within 60 days into a designated Roth account in an
employer plan if the payment is a nonqualified distribution
and the rollover does not exceed the amount of the
earnings in the payment. You cannot do a 60‑day rollover
to an employer plan of any part of a qualified distribution. If
you receive a distribution that is a nonqualified distribution
and you do not roll over an amount at least equal to the
earnings allocable to the distribution, you will be taxed on
the amount of those earnings not rolled over, including the
10% additional income tax on early distributions if you are
under age 59½ (unless an exception applies).
If you do a direct rollover of only a portion of the amount
paid from the Plan and a portion is paid to you at the
same time, the portion directly rolled over consists first
of earnings. If you do not do a direct rollover and the
payment is not a qualified distribution, the Plan is required
to withhold 20% of the earnings for federal income taxes
(up to the amount of cash and property received other than
employer stock). This means that, in order to roll over the
entire payment in a 60‑day rollover to a Roth IRA, you must
use other funds to make up for the 20% withheld.
How much may I roll over? If you wish to do a rollover, you
may roll over all or part of the amount eligible for rollover.
Any payment from the Plan is eligible for rollover, except:
• Required minimum distributions after age 70½ (if you were
born before July 1, 1949), after age 72 (if you were born
after June 30, 1949), or after death;
• Hardship distributions;
• Payments of employee stock ownership plan (ESOP)
dividends;
• Corrective distributions of contributions that exceed tax
law limitations; and
• Loans treated as deemed distributions (for example,
loans in default due to missed payments before your
employment ends).
The Administrator or the payor can tell you what portion of
a payment is eligible for rollover.
If I don’t do a rollover, will I have to pay the 10% additional
income tax on early distributions? If a payment is not
a qualified distribution and you are under age 59½, you
will have to pay the 10% additional income tax on early
distributions with respect to the earnings allocated to
the payment that you do not roll over (including amounts
withheld for income tax), unless one of the exceptions
listed below applies. This tax is in addition to the regular
income tax on the earnings not rolled over.
The 10% additional income tax does not apply to the
following payments from the Plan:
• Payments made after you separate from service if you will
be at least age 55 in the year of the separation;
• Payments made due to disability;
• Payments after your death;
• Payments of ESOP dividends;
• Corrective distributions of contributions that exceed tax
law limitations;
• Payments made directly to the government to satisfy a
federal tax levy;
• Payments made under a qualified domestic relations
order (QDRO);
• Payments of up to $5,000 made to you from a defined
contribution plan if the payment is a qualified birth or
adoption distribution;
• Payments up to the amount of your deductible medical
expenses (without regard to whether you itemize
deductions for the taxable year);
• Certain payments made while you are on active duty if
you were a member of a reserve component called to duty
after September 11, 2001 for more than 179 days; and
• Payments for certain distributions relating to certain
federally declared disasters.
If I do a rollover to a Roth IRA, will the 10% additional income
tax apply to early distributions from the IRA? If you receive a
payment from a Roth IRA when you are under age 59½, you will
have to pay the 10% additional income tax on early distributions
on the earnings paid from the Roth IRA, unless an exception
applies or the payment is a qualified distribution. In general,
the exceptions to the 10% additional income tax for early
distributions from a Roth IRA listed above are the same as the
exceptions for early distributions from a plan. However, there
are a few differences for payments from a Roth IRA, including:
• The exception for payments made after you separate
from service if you will be at least age 55 in the year of the
separation does not apply.
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• The exception for qualified domestic relations orders
(QDROs) does not apply (although a special rule applies
under which, as part of a divorce or separation agreement,
a tax‑free transfer may be made directly to a Roth IRA of a
spouse or former spouse).
If you receive a payment that is a qualified distribution that
includes employer stock and you do not roll it over, your
basis in the stock (used to determine gain or loss when you
later sell the stock) will equal the fair market value of the
stock at the time of the payment from the Plan.
• An exception for payments made at least annually in equal
or close to equal amounts over a specified period applies
without regard to whether you have had a separation
from service.
• There are additional exceptions for (1) payments for qualified
higher education expenses, (2) payments up to $10,000 used
in a qualified first‑time home purchase, and (3) payments
for health insurance premiums after you have received
unemployment compensation for 12 consecutive weeks
(or would have been eligible to receive unemployment
compensation but for self‑employed status).
Will I owe state income taxes? This notice does not describe
any state or local income tax rules (including withholding rules).
SPECIAL RULES AND OPTIONS
If you miss the 60-day rollover deadline: Generally, the
60‑day rollover deadline cannot be extended. However, the
IRS has the limited authority to waive the deadline under
certain extraordinary circumstances, such as when external
events prevented you from completing the rollover by the
60‑day rollover deadline. Under certain circumstances,
you may claim eligibility for a waiver of the 60‑day rollover
deadline by making a written self‑certification. Otherwise,
to apply for a waiver from the IRS, you must file a private
letter ruling request with the IRS. Private letter ruling
requests require the payment of a nonrefundable user
fee. For more information, see IRS Publication 590‑A,
Contributions to Individual Retirement Arrangements (IRAs).
If your payment includes employer stock that you do not
roll over: If you receive a payment that is not a qualified
distribution and you do not roll it over, you can apply a special
rule to payments of employer stock (or other employer
securities) that are paid in a lump sum after separation from
service (or after age 59½, disability, or the participant’s
death). Under the special rule, the net unrealized appreciation
on the stock included in the earnings in the payment will
not be taxed when distributed to you from the Plan and will
be taxed at capital gain rates when you sell the stock. If you
do a rollover to a Roth IRA for a nonqualified distribution
that includes employer stock (for example, by selling the
stock and rolling over the proceeds within 60 days of the
distribution), you will not have any taxable income and the
special rule relating to the distributed employer stock will
not apply to any subsequent payments from the Roth IRA or,
generally, the Plan. Net unrealized appreciation is generally
the increase in the value of the employer stock after it was
acquired by the Plan. The Plan administrator can tell you the
amount of any net unrealized appreciation.
If you have an outstanding loan that is being offset: If you
have an outstanding loan from the Plan, your Plan benefit may
be offset by the outstanding amount of the loan, typically
when your employment ends. The offset amount is treated
as a distribution to you at the time of the offset. Generally,
you may roll over all or any portion of the offset amount. If
the distribution attributable to the offset is not a qualified
distribution and you do not roll over the offset amount, you
will be taxed on any earnings included in the distribution
(including the 10% additional income tax on early distributions,
unless an exception applies). You may roll over the earnings
included in the loan offset to a Roth IRA or designated Roth
account in an employer plan (if the terms of the employer plan
permit the plan to receive plan loan offset rollovers). You may
also roll over the full amount of the offset to a Roth IRA.
How long you have to complete the rollover depends
on what kind of plan loan offset you have. If you have a
qualified plan loan offset, you will have until your tax return
due date (including extensions) for the tax year during which
the offset occurs to complete your rollover. A qualified
plan loan offset occurs when a plan loan in good standing is
offset because your employer plan terminates, or because
you sever from employment. If your plan loan offset occurs
for any other reason, then you have 60 days from the date
the offset occurs to complete your rollover.
If you receive a nonqualified distribution and you were born
on or before January 1, 1936: If you were born on or before
January 1, 1936, and receive a lump sum distribution that is not
a qualified distribution and that you do not roll over, special
rules for calculating the amount of the tax on the earnings in
the payment might apply to you. For more information, see
IRS Publication 575, Pension and Annuity Income.
If you are not a Plan participant
Payments after death of the participant. If you receive a
distribution after the participant’s death that you do not roll
over, the distribution will generally be taxed in the same manner
described elsewhere in this notice. However, whether the
payment is a qualified distribution generally depends on when
the participant first made a contribution to the designated
Roth account in the Plan. Also, the 10% additional income tax
on early distributions and the special rules for public safety
officers do not apply, and the special rule described under
the section “If you receive a nonqualified distribution and you
were born on or before January 1, 1936” applies only if the
participant was born on or before January 1, 1936.
rate of withholding under an income tax treaty. For more
information, see also IRS Publication 519, U.S. Tax Guide
for Aliens, and IRS Publication 515, Withholding of Tax on
Nonresident Aliens and Foreign Entities.
OTHER SPECIAL RULES
If your payments for the year (only including payments from
the designated Roth account in the Plan) are less than $200,
the Plan is not required to allow you to do a direct rollover
and is not required to withhold federal income taxes.
However, you can do a 60‑day rollover.
You may have special rollover rights if you recently served
in the U.S. Armed Forces. For more information on special
rollover rights related to the U.S. Armed Forces, see IRS
Publication 3, Armed Forces’ Tax Guide. You also may have
special rollover rights if you were affected by a federally
declared disaster (or similar event), or if you received a
distribution on account of a disaster. For more information
on special rollover rights related to disaster relief, see the
IRS website at www.irs.gov.
FOR MORE INFORMATION
You may wish to consult with the Plan Administrator or
payor, or a professional tax advisor, before taking a payment
from the Plan. Also, you can find more detailed information
on the federal tax treatment of payments from employer
plans in IRS Publication 575, Pension and Annuity Income; IRS
Publication 590‑A, Contributions to Individual Retirement
Arrangements (IRAs); IRS Publication 590‑B, Distributions
from Individual Retirement Arrangements (IRAs); and IRS
Publication 571, Tax-Sheltered Annuity Plans (403(b) Plans).
These publications are available from a local IRS office, on
the web at www.irs.gov, or by calling 800-TAX-FORM.
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If you are a surviving spouse: If you receive a payment from
the Plan as the surviving spouse of a deceased participant,
you have the same rollover options that the participant would
have had, as described elsewhere in this notice. In addition,
if you choose to do a rollover to a Roth IRA, you may treat
the Roth IRA as your own or as an inherited Roth IRA.
A Roth IRA you treat as your own is treated like any other
Roth IRA of yours, so that you will not have to receive any
required minimum distributions during your lifetime and
earnings paid to you in a nonqualified distribution before
you are age 59½ will be subject to the 10% additional income
tax on early distributions (unless an exception applies).
If you treat the Roth IRA as an inherited Roth IRA, payments
from the Roth IRA will not be subject to the 10% additional
income tax on early distributions. An inherited Roth IRA is
subject to required minimum distributions. If the participant
had started taking required minimum distributions from the
Plan, you will have to receive required minimum distributions
from the inherited Roth IRA. If the participant had not started
taking required minimum distributions, you will not have to
start receiving required minimum distributions from the
inherited Roth IRA until the year the participant would have
been age 70½ (if the participant was born before July 1, 1949)
or age 72 (if the participant was born after June 30, 1949).
If you are a surviving beneficiary other than a spouse: If you
receive a payment from the Plan because of the participant’s
death and you are a designated beneficiary other than a
surviving spouse, the only rollover option you have is to
do a direct rollover to an inherited Roth IRA. Payments
from the inherited Roth IRA, even if made in a nonqualified
distribution, will not be subject to the 10% additional income
tax on early distributions. You will have to receive required
minimum distributions from the inherited Roth IRA.
Payments under a QDRO: If you are the spouse or a former
spouse of the participant who receives a payment from the
Plan under a QDRO, you generally have the same options
and the same tax treatment that the participant would have
(for example, you may roll over the payment to your own
Roth IRA or to a designated Roth account in an eligible
employer plan that will accept it).
If you are a nonresident alien: If you are a nonresident
alien and you do not do a direct rollover to a U.S. IRA or
U.S. employer plan, and the payment is not a qualified
distribution, the Plan is generally required to withhold
30% (instead of withholding 20%) of the earnings for
federal income taxes. If the amount withheld exceeds the
amount of tax you owe (as may happen if you do a 60‑day
rollover), you may request an income tax refund by filing
Form 1040NR and attaching your Form 1042‑S. See Form
W‑8BEN for claiming that you are entitled to a reduced
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For more information
IF YOU HAVE QUESTIONS ABOUT…
WEBSITE
PHONE
When you’re eligible for benefits or how to enroll One.Walmart.com/Benefits
People Services: 800-421-1362
Medical benefits, claims, or care management
See Find a doctor and get medical plan help on the next page
Pharmacy benefits
One.Walmart.com/Prescriptions
OptumRx: 844-705-7493
Health savings account (HSA) for associates
enrolled in the Saver Plan
One.Walmart.com/Saver
HealthEquity: 866-296-2860
Learn.HealthEquity.com/Walmart/HSA
Centers of Excellence
One.Walmart.com/COE
BlueAdvantage: 866-823-3790
Digestive health program:
AK, AL, AZ, CO, IA, IL, IN, KY, MN,
MO, NC, SC, TN, VA, WI, WV
Digital physical therapy program:
AK, AL, AZ, CO, IA, IL, IN, KY, MN,
MO, NC, SC, TN, VA, WI, WV
Vision plan
Dental plan
Short‑term disability insurance
Aetna: 855-548-2387
UMR: 855-870-9177
HealthSCOPE: 800-804-1272
(See back of plan ID card)
One.Walmart.com/GIThrive
GIThrive: 833-336-9488
BlueAdvantage: 866-823-3790
Aetna: 855-548-2387
UMR: 855-870-9177
HealthSCOPE: 800-804-1272
One.Walmart.com/OmadaHealth
BlueAdvantage: 866-823-3790
Aetna: 855-548-2387
UMR: 855-870-9177
HealthSCOPE: 800-804-1272
(See back of plan ID card)
One.Walmart.com/Vision
VSP: 866-240-8390
One.Walmart.com/Dental
Delta Dental: 800-462-5410
One.Walmart.com/ShortTermDisability
(CA, CT, DC, HI, MA, NJ, NY, RI, WA;
refer to state guide)
Sedgwick/Lincoln: 800-492-5678
Long‑term disability insurance
One.Walmart.com/LongTermDisability
Lincoln: 877-353-6404
Accident and critical illness insurance
One.Walmart.com/Accident
Allstate Benefits: 800-514-9525
Life, accidental death and dismemberment
(AD&D), and business travel accident insurance
Resources for Living
Quit Tobacco
Walmart 401(k) Plan
One.Walmart.com/Critical
One.Walmart.com/Life
One.Walmart.com/ADD
One.Walmart.com/RFL
Prudential: 877-740-2116
800-825-3555, available 24/7
One.Walmart.com/QuitTobacco
Kick Buts: 855-955-1905
One.Walmart.com/401k
Merrill: 888-968-4015
Benefits.ML.com
Associate Stock Purchase Plan
One.Walmart.com/ASPP
ComputerShare: 800-438-6278
ComputerShare.com/Walmart
2022 Associate Benefits Book | Questions? Log on to One.Walmart.com or call People Services at 800-421-1362
Find a doctor and get medical plan help
Your contact information for medical plan help depends on two things:
• Where you work, or in some cases which plan you’re enrolled in.
• Which of our four plan administrators serves your area. You’ll find yours on the back of your plan ID card.
LOCATION OR PLAN
PLAN ADMINISTRATOR FIND A DOCTOR
CLAIMS, CUSTOMER SERVICE,
CARE MANAGEMENT
Most areas
BlueAdvantage
GrandRounds.com/Walmart
BlueAdvantage: 866-823-3790
Aetna
HealthSCOPE
Grand Rounds Health: 800-941-1384
Aetna: 855-548-2387
Virtual doctor visit:
One.Walmart.com/DOD
HealthSCOPE: 800-804-1272
Most areas
UMR
GrandRounds.com/Walmart
UMR: 855-870-9177
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i
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UMR: 855-870-9177
Virtual doctor visit:
One.Walmart.com/DOD
IL, IN, MO, NC, SC, VA
BlueAdvantage
GrandRounds.com/Walmart
Aetna
Personal Healthcare Assistant:
855-377-2200
Virtual primary care doctor:
One.Walmart.com/DOD
Grand Rounds Health:
855-377-2200
IL, MO, NC, SC
UMR
GrandRounds.com/Walmart
UMR: 855-870-9177
TX: Dallas, Houston,
San Antonio
AR: Northwest Arkansas
OK: Tulsa, Oklahoma City
FL: Tampa, Orlando,
Jacksonville, Gainesville
AK, AL, AZ, CO, IA, KY,
MN, TN, WI, WV
UMR: 855-870-9177
Virtual primary care doctor:
One.Walmart.com/DOD
BlueAdvantage
GrandRounds.com/Walmart
BlueAdvantage: 866-823-3790
BlueAdvantage: 866-823-3790
Virtual doctor visit:
One.Walmart.com/DOD
BlueAdvantage
GrandRounds.com/Walmart
Aetna
Grand Rounds Health: 800-941-1384
Virtual primary care doctor:
One.Walmart.com/DOD
Grand Rounds Health:
800-941-1384 (care management)
Aetna: 833-554-1544
BlueAdvantage: 866-823-3790
AL, CO, IA, MN, WI
UMR
GrandRounds.com/Walmart
UMR: 855-870-9177
UMR: 855-870-9177
Virtual primary care doctor:
One.Walmart.com/DOD
Mercy Arkansas Local
Plan, Ochsner Local Plan,
UnityPoint Local Plan
Hawaii
HealthSCOPE
GrandRounds.com/Walmart
HealthSCOPE Benefits:
800-804-1272
HMSA
Kaiser
HMSA.com: 808-948-6111
HMSA.com: 808-948-6111
KP.org: 808-532-5955 (Oahu),
800-966-5955 (all neighbor islands)
KP.org: 808-532-5955 (Oahu),
800-966-5955 (all neighbor islands)
Virtual doctor visit:
See HMO provider
PPO Plan
Aetna
GrandRounds.com/Walmart
Aetna: 855-548-2387
Grand Rounds Health: 800-941-1384
Teladoc: 800-835-2362
Virtual doctor visit:
Teladoc.com/Aetna
2022 Associate Benefits Book | Summary Plan Descriptions
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| © 2022 Walmart Inc.
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